Priya Wanchoo, MD, CHCP1*, Chris Larrison2, Tom McKeithen2, Kevan L. Hartshorn, MD3, Eric Hardt, MD,3 Diane L. Sarnacki3, RN, MSN, AOCN, Katie Finn3, and Julie White3

1Haymarket Medical Education

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2Healthcare Performance Consulting

3Boston University School of Medicine

A collaboration between



The objective of this initiative was to identify gaps in oncology clinicians’ knowledge, competence, and performance with respect to treatment of geriatric patients with cancer, whether in an academic medical center or community setting. Methods included a review of the literature; a series of in-depth, 60-minute telephone interviews with oncology clinicians (physicians, nurses, nurse navigators, pharmacists); and a 55-question survey for medical oncologists focusing on case scenarios. The study revealed five key gaps in achieving optimal care of the geriatric cancer patient: (1) Need for more specific guidance in developing treatment plans for patients with cancer and comorbidities; (2) Underutilization of tools to assess function, cognition, and support services; (3) Lack of compliance to medication regimens; (4) Lack of communication between oncology clinicians and primary-care clinicians; and (5) A need to understand that goals of treatment as defined by geriatric cancer patients may differ from those of younger patients. The results are intended to serve as a springboard for designing continuing medical education programs to help bridge gaps in knowledge and practice performance. Participants demonstrated a strong desire to increase their competence and a readiness to change practice patterns to help improve the quality of care for the geriatric patient with cancer.

Keywords: geriatrics; oncology; cancer; needs assessment; elderly; oncologists; education


1.  Introduction

This needs assessment aims to increase the awareness and understanding of the practice performance gaps in optimal care among multidisciplinary clinical team members engaged in the treatment of geriatric patients with cancer at academic medical centers and/or at community cancer centers and clinics in the United States (US). The targeted clinical team members of this initiative included geriatric oncologists, medical oncologists, radiation oncologists, surgical oncologists, oncology nurses, geriatric nurse practitioners (NPs), oncology nurse navigators (ONNs), and PharmDs in hospital settings. The overall goals of this needs assessment include:

  1. Determine the key knowledge‐based gaps of clinicians who treat geriatric patients with cancer
  2. Determine the key competence‐based gaps of clinicians who treat geriatric patients with cancer
  3. Design educational strategies based on key findings
  4. Publish results of this needs assessment for use by the continuing medical education (CME)/continuous professional development (CPD) community
  5. Disseminate this needs assessment to appropriate groups for use in educational planning

The project partners investigated clinical perspectives by utilizing a multi‐method, validated needs assessment conducted by experts in survey design and execution, clinical oncology issues, and clinician engagement. Findings from this needs assessment will inform the development of future performance interventions, such as CME activities. The results of this needs assessment—the identification of five key gaps in clinician knowledge, competence, and performance—are intended to serve as a springboard for the design of educational platforms that will bridge educational and performance gaps in the treatment of elderly patients with cancer, while recognizing the importance of individualized patient needs that will improve the quality of care.