Success Story: A compassionate approach to detecting and treating skin cancer among the institutionalized elderly

Suspecting that malignant and pre-malignant skin lesions occur commonly among nursing home residents, radiation oncologist Dr. Jan Lim set about to pilot an approach to improving the delivery of early cancer detection and treatment to these residents. Dr. Lim wanted to bring expertise in detecting cancerous skin lesions to residents in an efficient and compassionate manner given the special considerations required for patients who may have limited lifespans and/or challenges with mobility. He devised a plan to visit each residential care facility to provide an on-site assessment to identify and distinguish those cancers that can be watched from those that needed to be treated fairly quickly, as well as some situations where a biopsy was necessary.

After discussions with the Long Term Care Medical Advisory Committee and the Medical Director of Residential Services for Island Health, in-house consultations commenced in February 2018. Over the course of 14 months, Dr. Lim performed 49 in-house consultations on 42 residents of long-term care facilities in Greater Victoria.

The results of his pilot study were impressive: of the 42 residents who were assessed, 26 of them did not require or were unsuitable for radiation therapy. Thus, in-house assessment by Dr. Lim reduced the amount of required travel for assessment and treatment by 79%, improving the level of care and convenience to the residents as well as reducing the resources expended for transfer and clinic space at the cancer center. 14 of the residents who had early skin cancers detected could be treated with fewer visits to the cancer center.

In the process of doing this study, Dr. Lim realized that the prevalence of skin cancer in the 9 residential homes in Victoria appears to be much lower than the 10-15% reported in Australian studies. Based on the referred cases, the prevalence appears to be around 1-3%.

Dr. Lim credits the funding from the South Island Facility Engagement Initiative with providing a platform for him to engage in this preliminary exploration. “Without the funding, I wouldn’t have known that the numbers [of skin cancer cases] in local residential homes were so small that I didn’t need a budget to hire a data collection person. Given the Australian projections, I would have expected many more cases. I would have thought that I needed a lot more help and I wouldn’t have taken it on without a source of funding”.

Though Dr. Lim is retiring in July 2019, he hopes this study will lead to future initiatives to provide in-house services to residential patients. “There are lots of efficiencies to be gained”, says Dr. Lim. “It’s a question of how to better direct the resources for elderly patients”.

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