INTRODUCTION:Cancer and ageing have a bidirectional relationship: age is the strongest risk factor for cancer, and cancer and treatments can accelerate ageing. Therefore, biological age can differ from chronological age; biomarkers are needed to stratify interventions to minimise accelerated ageing. METHODS:PhenoAge was calculated from routine blood test results of patients attending a Geriatric Oncology clinic. PhenoAgeAccel was the residual from a regression of PhenoAge against age. RESULTS:Data were available for 173 patients (62% male). Mean PhenoAge was higher than age (84.3 (12.6) vs 76.2 (7.24), p < 0.001), though the two were correlated (r = 0.579, p < 0.001). Unlike age, PhenoAge and PhenoAgeAccel were associated with one-year mortality (PhenoAge OR=1.083, 95% CI: 1.038-1.136; PhenoAgeAccel OR=1.096, 95% CI: 1.047-1.155). PhenoAge correlated with Clinical Frailty Score and Timed Up and Go (CFS: Rs=0.31, p < 0.001; TUG: Rs=0.25, p < 0.005); there were no correlations with age. PhenoAgeAccel correlated with the number of CGA interventions made (Rs=0.17, p < 0.05), unlike age and PhenoAge. Patients with diabetes mellitus had a higher PhenoAgeAccel compared to those without (3.40 vs -1.71, p = 0.002). In patients receiving systemic anti-cancer treatment, patients with PhenoAgeAccel calculated pre-treatment had less age acceleration than those with PhenoAgeAccel calculated post-treatment, both overall (2.18 vs -2.87; p = 0.048) and in matched samples (n = 21, 7.76 vs -2.87, p < 0.001). CONCLUSIONS:PhenoAgeAccel is a greater predictor of risk than chronological age in older people with cancer. This makes it a promising biomarker to stratify patients for holistic geriatric assessment, dose reductions, or future geroprotective measures which could be integrated within electronic healthcare record systems.

Results: 82 pt completed GA, of which 70 (85%) wore FB for ≥1 day.Median SPD for all pt was 2222 (range 38-11032).Pt with ≤ median SPD were older (75 vs 72 p = 0.027), female (31% vs 14% p = 0.15), Black (23% vs 9%, p = 0.08), living alone (29% vs 14% p = 0.24).Groups had similar distributions of education level (≤12 yrs 34% vs 31% p = 0.99) and stage (>2 83% vs 80% p = 0.99).Pt with <2222 SPD were more likely to have other GA abnormalities (mean count 2.09 vs 1.31 p = 0.006), self-reported PS >2 (23% vs 0% p = 0.013), and impaired IADL (54% vs 9% p < 0.001).Patients with lower SPD had higher rates ≥Gr 3 toxicity (46% vs 20% p = 0.15) and hospitalization (31% vs 6% p = 0.006).The rate of abnormal TUG was similar in both groups (20% vs 17% p = 0.4).Conclusions: FB use is feasible among OA with GEC and provides objective data regarding pt's function which correlates with other GA abnormalities and treatment tolerance.

Introduction: Hyperglycaemia increases cancer treatment toxicity, morbidity & mortality.We developed a proactive pathway for hyperglycaemic risk stratification & management.High risk patients were managed by the diabetes team, intermediate risk by geriatrics (GOLD) and low risk by oncology.Objectives: Evaluate the feasibility and utility of glycaemic control optimisation in intermediate hyperglycaemic risk older cancer patients.Methods: Intermediate risk patients managed by GOLD monitored their capillary blood glucose (CBG) at home.Serial CBGs and treatment progress were recorded.Results: 38 intermediate risk patients (63% [24/38] with preexisting diabetes) were referred to GOLD (Feb 22-Mar 23). 4 patients required immediate diabetes team referral, 4 patients did not start steroids.Of the remaining 30, 63% (19/30) required a glucometer arranging.93% (28/30) measured CBG at home successfully.Of the 28 who measured CBG, 39.2% (11/28) required intervention.17.9% (5/28) required gliclazide on steroid days with dose titration, 21.4% (6/28) required later insulin with the diabetes team.No hyperglycaemia-related admissions occurred.Conclusion: Glucose monitoring in cancer patients at intermediate risk of hyperglycaemia was feasible.Interventions were required in over a third of intermediate risk patients suggesting all but low risk patients require careful management.Shared pathways between different specialists appear to support reducing the burden to diabetes services by utilising services with Internal Medicine expertise.

INTRODUCTION:Parkinson's disease is the second most common chronic neurodegenerative condition with bladder dysfunction affecting up to 71%. Symptoms affect quality of life and include urgency, frequency, hesitancy, nocturia and incontinence. Addressing urinary dysfunction is one of the top 10 priority research areas identified by the James Lind Alliance and Parkinson's UK.OBJECTIVES:Conduct a randomised controlled trial (RCT) targeting people with Parkinson's disease (PwP) who have self-reported problematic lower urinary tract symptoms, investigating the effectiveness of transcutaneous tibial nerve stimulation (TTNS) compared with sham TTNS. Implement a standardised training approach and package for the correct application of TTNS. Conduct a cost-effectiveness analysis of TTNS compared with sham TTNS.METHODS AND ANALYSIS:An RCT of 6 weeks with twice weekly TTNS or sham TTNS. Participants will be recruited in 12 National Health Service neurology/movement disorder services, using a web-based randomisation system, and will be shown how to apply TTNS or sham TTNS. Participants will receive a weekly telephone call from the researchers during the intervention period. The trial has two coprimary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score. Secondary outcomes include a 3-day bladder diary, quality of life, acceptability and fidelity and health economic evaluation. Outcomes will be measured at 0, 6 and 12 weeks.A sample size of 208 randomised in equal numbers to the two arms will provide 90% power to detect a clinically important difference of 2.52 points on the Internatioanl Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and of 3 points in the International Prostate Symptom Score total score at 12 weeks at 5% significance level, based on an SD of 4.7 in each arm and 20% attrition at 6 weeks. Analysis will be by intention to treat and pre defined in a statistical analysis plan ETHICS AND DISSEMINATION: East of Scotland Research Ethics Service (EoSRES), 18/ES00042, obtained on 10 May 2018. The trial will allow us to determine effectiveness, safety, cost and acceptability of TTNS for bladder dysfunction in PWP. Results will be published in open access journals; lay reports will be posted to all participants and presented at conferences.TRIAL REGISTRATION NUMBER:ISRCTN12437878; Pre-results.

Background Many older people who are living with cancer do so with concurrent complex health and social issues. Assessment and treatment planning for cancer often focus primarily on the disease, missing opportunities to identify and address these significant wider concerns.Aim To gain an understanding of the factors that can increase or reduce older people’s capacity to manage the workload associated with the self-management of cancer and other conditions.Method Secondary analysis of questionnaire data comprising 224 responses to 19 structured items covering health and daily living issues and analysis of free-text responses, focusing on factors affecting an individual’s capacity to manage their workload associated with living with cancer.Results Reduced physical function affected many respondents’ capacity to manage their health and other responsibilities and to live their everyday lives. Many respondents were concerned about continuing to care for those dependent on them and identified factors that enhanced their capacity in their social network and from healthcare professionals. Organisational factors such as scheduled appointments, transport and availability of parking further affected respondents’ capacity.Conclusion There is an implicit need to identify and address the main factors that can increase an individual’s capacity to manage their health and to support the delivery of person-centred cancer treatment and care plans.

The COVID-19 pandemic has added new challenges to the delivery of care in older patients with cancer. Advanced age, malignancy, and multi-comorbidities are associated with increased severity of COVID-19 disease and subsequent mortality [1,2]. There has become a difficult balance of risk versus benefit for all cancer treatment types during the pandemic, with decision-making most complex for those with multiple comorbidities or frailty. In March 2020, United Kingdom (UK) government mandated health service changes came into effect to accommodate the treatment of large numbers of COVID-19 patients.

Key content Gynae‐oncology patients are increasingly older and living with frailty and multimorbidity, resulting in higher rates of perioperative or treatment‐associated adverse outcomes. Collaborative shared decision making (SDM), where healthcare professionals and patients work in partnership to reach a treatment decision, can be used to engage patients in treatment decisions. Comprehensive geriatric assessment (CGA), a multidimensional, interdisciplinary process assessing medical, psychological and functional capabilities, can inform individualised management and SDM in older gynae‐oncology patients with complex conditions. Evidence is emerging for the use of CGA to inform individualised management and underpin integrated care pathways and SDM for older people. This methodology is advocated in NHS England’s Cancer Strategy through integrated pathways for older cancer patients with geriatrician involvement. Using clinical case studies, this review contextualises the application of SDM through CGA in older patients with gynaecological malignancy. Learning objectives Know that SDM takes proposed risks and benefits into account, together with projected disease progression with and without treatment and patient preferences. Understand that limitations to SDM in older people include the effects of multimorbidity, cognitive impairment and frailty, limited data on long‐term clinician and patient‐reported outcomes and frequent exclusion of older people from research trials.

Background It is widely accepted that advancing age is associated with worse COVID-19 outcomes. However, there is insufficient data analyzing the impact of COVID-19 in the older cancer population. The aim of the study is to establish if age has an influence on severity and mortality of COVID-19 in cancer patients. Methods We reviewed 306 oncology patients with PCR-confirmed COVID-19 from Guy's Cancer Centre and its partner Trust King's College Hospital, between 29 February - 31 July 2020. Demographic and tumor characteristics in relation to COVID-19 severity and death were assessed with logistic and Cox proportional hazards regression models, stratified by age (≤65 and >65 years). Severity of COVID-19 was classified by World Health Organization (WHO) grading. Results A total of 135 patients were aged ≤65 years (44%) and 171 aged >65 (56%). Severe COVID-19 presentation was seen in 27% of those aged ≤65 and 30% of those aged >65. The COVID-19 mortality rate was 19% in those aged ≤65 and 27% in those aged >65. In the older cohort, there was an increased incidence of severe disease in Caucasian ethnicity compared to the younger cohort (55% vs 43%) and compared to severe disease in Black and Asian ethnicities. There were increased co-morbidities in the older cohort including hypertension (54% vs 32%), diabetes (30% vs 12%) with increased rate of poly-pharmacy (62% vs 40%) compared to the younger cohort. In terms of cancer characteristics in the older cohort, there was a higher rate of patients with cancer for more than 2 years (53% vs 32%) and performance status of 3 (22% vs 6%). In terms of severity, Asian ethnicity [OR: 3.1 (95% CI: 0.88-10.96) p=0.64] had greater association with increasing COVID-19 severity in those aged >65. Interestingly, there were no positive associations between number of co-morbidities, treatment paradigm or performance status with severity of disease in the older group. The risk of mortality was greater in the elderly cohort with hematological cancer types [HR: 2.69 (1.31-5.53) p=0.85] and having cancer for more than 2 years [2.20 (1.09-4.42) p=0.28] compared to the younger cohort. Conclusions In our study we demonstrate that severity and mortality of COVID-19 did not significantly differ between the two age cohorts except in regards to Asian ethnicity, hematological malignancies and having cancer for more than 2 years. As expected, the older population had more co-morbidities and polypharmacy. Despite this, the incidence of severe COVID-19 was similar regardless of age. Further analyses for other geriatric presentations are ongoing to understand their interaction with COVID-19 in the cancer population.

Background increasing numbers of older people are undergoing vascular surgery. Preoperative comprehensive geriatric assessment and optimisation (CGA) reduces postoperative complications and length of hospital stay. Establishing CGA-based perioperative services requires health economic evaluation prior to implementation. Through a modelling-based economic evaluation, using data from a single site clinical trial, this study evaluates whether CGA is a cost-effective alternative to standard preoperative assessment for older patients undergoing elective arterial surgery. Methods an economic evaluation, using decision-analytic modelling, comparing preoperative CGA and optimisation with standard preoperative care, was undertaken in older patients undergoing elective arterial surgery. The incremental net health benefit of CGA, expressed in terms of quality-adjusted life-years (QALYs), was used to evaluate cost-effectiveness. Results CGA is a cost-effective substitute for standard preoperative care in elective arterial surgery across a range of cost-effectiveness threshold values. An incremental net benefit of 0.58 QALYs at a cost-effectiveness threshold of £30k, 0.60 QALYs at a threshold of £20k and 0.63 QALYs at a threshold of £13k was observed. Mean total pre- and postoperative health care utilisation costs were estimated to be £1,165 lower for CGA patients largely accounted for by reduced postoperative bed day utilisation. Conclusion this study demonstrates a likely health economic benefit in addition to the previously described clinical benefit of employing CGA methodology in the preoperative setting in older patients undergoing arterial surgery. Further evaluation should examine whether CGA-based perioperative services can be effectively implemented and achieve the same clinical and health economic outcomes at scale.

Background Rapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy’s RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population. Methods We evaluated all patients referred to Guy’s RDC between December 2016 and June 2019 ( n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service. Results There were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)—with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15–47) and treatment 56 days (IQR 32–84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%). Conclusions RDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%—justifying the RDC approach in vague symptom patients.

Abstract Urinary incontinence is not an inevitable consequence of ageing and its impact on social, psychological, and physical well-being is comparable to that of other chronic conditions such as diabetes and dementia. Meanwhile, constipation, including symptoms of evacuation difficulty and/or fewer bowel movements, is a common problem as people age. Risk factors include problems in cognition, mobility, gastrointestinal motility, dysautonomia, anorectal dysfunction, and disabling neurologic disorders. Faecal incontinence is more common in frail individuals but is often assessed inadequately. The cause is often multifactorial. Treatment depends on the cause: a combination of approaches may be necessary, including avoidance of faecal impaction, instigation of a structured bowel care plan including regular prompted toileting, dietary modification, and (in some cases) use of loperamide or similar medications.

BACKGROUND National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.AIM To identify current assessment methods and access to relevant supporting services for older people with cancer.METHODS A web-based survey（Survey Monkey） targeting health professionals（oncologists,cancer surgeons, geriatricians, nurses and allied health professionals） was distributed January-April 2016 via United Kingdom nationally recognised professional societies. Responses were analysed in frequencies and percentages.Chi Square was used to compare differences in responses between different groups.RESULTS640 health care professionals responded. Only 14.1% often/always involved geriatricians and 52.0% often/always involved general practitioners in assessments. When wider assessments were used, they always/often influenced decision-making（40.5%） or at least sometimes（34.1%）. But 30.5%-44.3% did not use structured assessment methods. Most clinicians favoured clinical history taking. Few used scoring tools and few wished to use them in the future. Most had urgent access to palliative care but only a minority had urgent access to other key supporting professionals（e.g. geriatricians, social workers, psychiatry）. 69.6%were interested in developing Geriatric Oncology services with geriatricians.CONCLUSION There is variability in assessment methods for older people with cancer across the United Kingdom and variation in perceived access to supporting services.Clinical history taking was preferred to scoring systems. Fostering closer links with geriatricians appears supported.

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.