Understanding and improving well-being of frail older people with cancer: longitudinal study and randomised controlled trial

Older people with cancer are affected by complex and prolonged health problems towards the end of life due to cumulative effects of co-existing chronic conditions associated with old age, such as frailty. According to the WHO, palliative care should be initiated early in the course of disease of these patients.

However, many do not receive palliative care, or only shortly before death. First, to better understand the complex needs of older people with cancer, I will examine the diversity of trajectories of physical and psychosocial well-being towards the end of life in this population. I will use data of an existing longitudinal study of older people with cancer that has collected data since 2010. Secondly, I will evaluate the feasibility, preliminary effectiveness, and effective components of palliative care for frail older cancer patients by extending an ongoing pilot fast-track randomised controlled trial in frail older people and oversampling cancer patients. The trial will test a short-term specialist palliative care intervention in primary care, developed through an innovative theory-based methodology. Fifty older cancer patients will be randomised to either receive the intervention immediately (fast-track) or after a 12-week wait (with standard best practice care). I will conduct outcome (patient and family) and process evaluation. This project will result in ground-breaking evidence for improving care in the final phase of life of older people with cancer.