Providing geriatric oncology care using telemedicine for older patients with cancer during the COVID-19 pandemic in Mexico.

The objective of this study was to describe our experience using readily available telemedicine tools to deliver specialist multidisciplinary care to older adults with cancer at a Mexican medical centre during the COVID-19 pandemic. Between March 2020 and March 2021, patients aged ≥65 years with colorectal or gastric cancer treated at a geriatric oncology clinic in Mexico City were included. Patients were reached via telemedicine utilising readily available apps such as WhatsApp or Zoom. We performed interventions such as geriatric assessments, treatment toxicity assessments, physical examinations and treatment prescription. The number of visits per patient, type of device used, preferred software/app, consultation barriers and the ability of the team to deliver complex interventions were analysed and reported. A total of 44 patients received at least one telehealth visit, with a total of 167 consultations. Only 20% of patients had webcam-equipped computers, and 50% of visits were performed using a caregiver's device. Seventy-five percent of visits took place using WhatsApp, and 23% using Zoom. The average visit lasted 23 minutes, with only 2% not completed due to technical issues. A geriatric assessment was successfully conducted in 81% of telemedicine visits, and chemotherapy was prescribed remotely in 32%. The use of telemedicine is possible in older adults with cancer living in developing countries and with little previous exposure to digital technology using readily available platforms such as WhatsApp. Healthcare centres in developing countries should make efforts to enhance the use of telemedicine, particularly for vulnerable populations such as older adults with cancer.

Effect of a geriatric unit in the outcomes of hospitalized older Mexican adults with cancer: A case-control study.

INTRODUCTION: Geriatric interventions may improve the care of hospitalized older adults with cancer, but information regarding their effect on geriatric-specific outcomes is lacking. We studied the effect of a specialized geriatrician-led inpatient geriatric management unit compared with a conventional internal medicine ward on the outcomes of hospitalized older adults with cancer in Mexico. MATERIALS AND METHODS: Case-control study including persons aged ≥65 years with solid malignancies who had a cancer-related hospitalization at a university-affiliated hospital in Mexico City. Patients hospitalized in a geriatric unit (cases) were paired 1:2 with those in internal medicine wards (controls). Matching criteria included: age (+/- five years), tumor type (according to International Classification of Diseases [ICD]-10 code), and admission date (+/- three months). The association between being hospitalized in the geriatric unit on various outcomes was determined using conditional logistic regression models. RESULTS: One hundred cases and 200 controls were included. Mean age was 75.3 years (standard deviation 6.4 years) and 53% had gastrointestinal tumors. No difference in median length-of-stay was found between cases and controls (9.0 days, vs. 9.5 days, p = 0.34). Hospitalization in the geriatric unit was associated with a reduced risk of delirium (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.04-0.80). Being hospitalized in the geriatric unit was not associated with an effect on hospital-acquired complications (OR 0.83, 95% CI 0.47-1.45) or in-hospital mortality (OR 1.82, 95% CI 0.32-10.18). DISCUSSION: Among older Mexican adults hospitalized for a cancer-related diagnosis, receiving care in a geriatric management unit was associated to a decreased risk of delirium, without influencing other outcomes.

Financial Toxicity Among Older Mexican Adults With Cancer and Their Families: A Mixed-Methods Study.

PURPOSE: The financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden. METHODS: This mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives. RESULTS: Ninety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care. CONCLUSION: A high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.

American Society of Clinical Oncology-Sponsored Oncology Student Interest Groups in Latin America.

PURPOSE: To describe the characteristics of the members of the ASCO-sponsored Oncology Student Interest Groups (OSIGs) in Latin America. METHODS: This was a multicenter cross-sectional study. We surveyed 97 OSIG members from three medical schools in Peru and Mexico. We administered a 60-question survey covering topics including personal background, oncology training experience, and professional practice expectations and preferences. RESULTS: A little more than one half of the surveyed OSIG members were female. More than one half had a visa to visit the United States and had an advanced level of English. One half of the OSIG members were also ASCO members. Most participants agreed or strongly agreed that participation in their OSIG increased their interest in cancer-related specialties (94%) and provided professional networking opportunities (94%) and that it was accessible to all students (91%). Most participants believed that their OSIG had sufficient resources to carry out its activities. Students were asked to rate their interest when they entered medical school versus at the time of the survey. Most of the members were strongly interested in pursuing surgical oncology. The majority of members were somewhat interested or very interested in palliative care and medical oncology. CONCLUSION: To our knowledge, this is the first study that provides data on medical student perceptions of the Latin American OSIGs sponsored by ASCO. Student perceptions of medical oncology and the impact of OSIGs were generally positive. Given the shortages of oncology specialists in Latin American and elsewhere, strategies to engage medical students in the pursuit of cancer-related careers are becoming increasingly essential.