Embedding Geriatric Assessment in the Colorectal Cancer Pathway

More than half of all cancers are diagnosed in people aged over 70, and around 70% of cancer deaths occur in people aged 65 and over. In Wales, the number of new cancer diagnoses is expected to rise significantly over the coming decade, driven largely by an ageing population.

Older adults with cancer often have complex needs linked to frailty, co-morbidities, medication, mobility, nutrition, cognition and wider social circumstances. When these needs are not systematically assessed, treatment decisions may not fully reflect what is right for the individual patient. This can contribute to over- or under-treatment, avoidable toxicity, longer hospital stays and poorer outcomes.

Comprehensive Geriatric Assessment provides a structured way to assess an older person’s overall health, functional ability and wider needs before treatment decisions are made. Evidence shows that pre-treatment geriatric assessment can influence cancer treatment decisions, help identify previously unrecognised risk factors, reduce severe treatment toxicity and support safer, more personalised care.

This work will introduce structured Comprehensive Geriatric Assessment within Cardiff & Vale University Health Board’s cancer services, starting with the colorectal cancer pathway. It will evaluate how this established approach can be integrated into cancer pathway decision-making, with learning used to inform its potential application in other tumour sites and across Wales.

Led by Consultant Geriatrician, Dr Juliette Lewis-Jones, the funding will establish a weekly multidisciplinary geriatric oncology clinic working alongside the colorectal team. The clinic, for patients aged 65 and over living with frailty, will support personalised treatment planning, helping ensure decisions are informed by a patient’s overall health, functional ability and priorities.

This investment builds directly on international learning from the Princess Margaret Cancer Centre in Toronto, following a  visit by Dr Lewis-Jones and colleagues in 2025 supported through our Keith James Grants. This funding now helps translate that learning into practice for patients in Wales. 

Use of this model at cancer centres of excellence around the world has evidenced the valuable impact it can have in improving decision-making and optimising outcomes for this cohort of patients. 

Over 12 months, the work aims to:

• Improve treatment decision-making for older adults with colorectal cancer
• Reduce avoidable treatment toxicity and unplanned admission
• Improve treatment adherence through decision-making processes tailored to the individual patient
• Enhance patient and caregiver experience
• Strengthen multidisciplinary coordination and staff experience within the pathway
• Generate learning on how geriatric assessment can be operationalised within cancer pathways
• Share evidence and learning to inform wider access to geriatric assessment for older adults with cancer across Wales

Alongside the clinic, the team will capture clinical, operational and experience data to understand what difference the approach makes for patients, staff and services, and how similar assessment models could be introduced in other appropriate tumour sites.