A Comprehensive Oncology Program for Elders (COPE)

Ponnandai S. Somasundar, MD, MPH, FACS, Vice Chairman of Surgery; Associate Chief, Division of Surgical Oncology; Director of Geriatric Oncology Program; Associate Professor of Surgery, Department of Surgery
M. Erkan Ceyhan, PhD, Director, Center for Quality & Outcomes for Surgery & Oncology
Roger Williams Medical Center

The COPE program enrolls and manages geriatric patients who have been diagnosed with cancer and engages their family members and caregivers. Patients are assessed at time of diagnosis, 30-, 60-, 90-, and 180-days after the initial diagnosis. The program takes a holistic care approach by utilizing tools and assessments, such as: 1) delirium risk, 2) cognitive assessment, 3) difficulty swallowing, 4) depression screening, 5) patient-reported quality of life measurement, 6) malnutrition assessment, 7) palliative care screening, 8) impaired functional status, 9) impaired mobility, and 10) timed up and go (TUG) test. A multidisciplinary team reviews the results of these assessments. When a risk factor is identified, care intervention is coordinated by a nurse navigator. Research faculty use patient data to develop risk stratification approaches that predict outcomes based on longitudinal assessments, labs, prospective treatment modalities, and comorbidities. A user-friendly Microsoft Excel based-tool monitors patient information including enrollment, compliance, status of assessments and interventions, referrals, and risk scores.