Capacity to Provide Geriatric Specialty Care for Older Adults in Community Oncology Practices

BackgroundAmerican Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to implement these guidelines and to facilitate geriatric oncology research.Materials and MethodsOncology practices within the National Cancer Institute Community Oncology Research Program (NCORP) were electronically surveyed in 2017 regarding the availability of specialty providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research capacity.ResultsOf the 943 NCORP practices, 504 (54%) responded to the survey, representing 210 practice groups. The median new cancer cases per year ≥65 years of age was 457 (interquartile range 227–939). Of respondents, only 2.0% of practices had a fellowship‐trained geriatric oncologist on staff. Geriatricians were available for consultation or comanagement at 37% of sites, and of those, only 13% had availability within the oncology clinic (5% of overall). Practice size of ≥1,000 new adult cancer cases (ages ≥18) per year was associated with higher odds (1.81, confidence interval 1.02–3.23) of geriatrician availability. Other multidisciplinary care professionals that could support GA were variably available onsite: social worker (84%), nurse navigator (81%), pharmacist (77%), dietician (71%), rehabilitative medicine (57%), psychologist (42%), and psychiatrist (37%).ConclusionOnly a third of community oncology practices have access to a geriatrician within their group and only 5% of community sites have access within the oncology clinic. Use of primarily self‐administered GA tools that direct referrals to available services may be an effective implementation strategy for guideline‐based care.Implications for PracticeOnly a minority of community oncology practices in the U.S. have access to geriatric specialty care. Developing models of care that use patient‐reported measures and/or other geriatric screening tools to assess and guide interventions in older adults, rather than geriatric consultations, are likely the most practical methods to improve the care of this vulnerable population.     

Prevalence of vitamin B12 deficiency in healthy Indian school‐going adolescents from rural and urban localities and its relationship with various anthropometric indices: a cross‐sectional study

Background

Micronutrient deficiency is a global health burden, especially among developing countries. The present cross‐sectional study aimed to determine the prevalence of vitamin B₁₂ deficiency in healthy Indian school‐going adolescents, based on area of residence, sex and body mass index (BMI) . Furthermore, the relationship of serum B₁₂ concentration with dietary vitamin B₁₂ intake and anthropometric indices was assessed among adolescents from rural and urban India.

Methods

A total of 2403 school‐going adolescents (11–17 years) from National Capital Region and rural areas of Haryana, India were selected. Serum B₁₂ concentrations were estimated using an electrochemiluminescence immunoassay. Dietary assessments were conducted on 65% of total participants (n  = 1556) by two 24‐h diet recalls.

Results

The prevalence of vitamin B₁₂ deficiency in the total study population was 32.4% (rural: 43.9% versus urban: 30.1%, P  < 0.001; male: 34.4% versus female: 31.0%, P  < 0.05; normal weight: 28.1%, versus overweight: 39.8%, versus obese: 51.2%, P  < 0.001). More than half (51.2%) of obese adolescents were vitamin B₁₂ deficient. On multiple linear regression analysis, serum B₁₂ in rural adolescents was associated with age (β = ?0.12, P  < 0.05). Among urban adolescents, serum B₁₂ was associated with BMI (β = ?0.08, P  < 0.05) and adjusted dietary vitamin B₁₂ intake (β = 0.14, P  < 0.001). Serum vitamin B₁₂ levels were found to be lower in rural females (β = ?0.12, P  = 0.030) and urban males (β: 0.11, P  < 0.001) compared to their respective contemporaries.

Conclusions

Vitamin B₁₂ deficiency was higher among rural school‐going adolescents. Boys had a higher B₁₂ deficiency than girls. Inverse associations of serum B₁₂ with adiposity indices were observed. Serum B₁₂ levels were positively associated with dietary vitamin B₁₂ intake.