The Geriatric Oncology LongituDinal End to eNd (GOLDEN) Programme

Singapore is seeing a rising number of cancer diagnoses among its ageing population. Older adults with cancer require a nuanced approach to care, as: 

• Their needs extend beyond what traditional oncology assessment typically address. Conventional evaluation focuses largely on physical health for treatment, which can overlook other common issues in older cancer patients: multiple medical conditions, sarcopenia (age-related muscle loss), falls risk, cognitive and sensory impairment, polypharmacy, malnutrition, and psychosocial vulnerability.
• They worry about whether they are fit to undergo cancer treatment at their age, and are concerned that the treatment may compromise their quality of life.

The GOLDEN programme addresses these complex needs and concerns by providing a comprehensive geriatric assessment (CGA) for every referred patient. This holistic approach focuses on the patient rather than the illness, and enables the GOLDEN team to develop personalised management plans aligned with each patient’s needs and goals. This ensures timely access to appropriate services and support at every stage of their cancer journey.

Our programme supports older adults and their families as they navigate the challenges with cancer diagnosis. This includes:

• Older adults aged 65 and above who have been diagnosed with cancer and referred to us
• Cancer patients aged 75 and above who have been systematically screened at the National University Cancer Institute, Singapore (NCIS) with the Geriatric 8 (G8) tool and identified as needing comprehensive geriatric assessment
• Caregivers seeking dedicated support service

The GOLDEN team ensures older adults and their families receive the most suitable care through a 3-step approach:

Deliver multidisciplinary, end-to-end care

As the only end-to-end geriatric haematology-oncology programme in the region, we support older adults throughout their cancer journey from prehabilitation through surgery, chemotherapy, radiation, to post-treatment rehabilitation. Patients benefit from the collective expertise of a dedicated care team comprising pharmacists, care coordinators, medical social workers, physiotherapists, occupational therapists, dietitians, nurses, geriatricians, haematologists, medical oncologists, and radiation oncologists.

Streamline care through a hybrid model with telemedicine 

We leverage a unique hybrid care model that integrates telemedicine into routine clinical practice to enhance efficiency, accessibility, and patient experience.

As part of the CGA process, we conduct interviews with patients or caregivers via phone or video calls up to two days before clinic visits. This allows the care team to identify concerns early and make timely adjustments to treatment plans, while reducing the frequency and duration of in-person clinic visits.

After initiating cancer treatment, the GOLDEN team closely monitors frail older adults at risk of chemotoxicity through bi-weekly phone or video calls. These regular reviews enable the team to proactively follow up on the patients’ health status and manage treatment-related side effects such as symptoms, toxicities, and geriatric syndromes.

• 60.8% of patients experienced a change in their treatment plan comprehensive review.
• Close to 70% of patients were identified to have geriatric syndromes that would have been missed without a CGA. Geriatric syndromes are known to be associated with poorer outcomes including reduced quality of life, increased risk of hospitalisation, functional decline, institutionalisation, and increased healthcare costs.
• 93% of respondents maintained or improved their quality of life, with 97% indicating that they benefited from the programme.

• Guidance and support key to beating cancer in old age
• Health Matters – Geriatric Oncology
• Soul of Business: Optimising Care for Older Adults with Cancer
• 老年癌症患术前术后复健组足疗效 （Efficacy of prehabilitation and rehabilitation in geriatric cancer patients)
• 国大癌症中心与医院推计划 助老年癌患者改善生活素质 (National cancer centre and hospital launch programme to improve quality of life for elderly cancer patients)
• 国大癌症中心与医院推计划 助老年癌患者改善生活素质(National cancer centre and hospital launch programme to improve quality of life for elderly cancer patients)
• 97岁患直肠癌末期 不放弃治疗 两次手术后康复 (At 97 years old, diagnosed with terminal rectal cancer, he refused to abandon treatment and recovered after two operations)
• 97岁癌末嬷 两动手术康复 - 地方 - 狮城二三事 (97-year-old terminal cancer patient recovers after two surgeries)
• 97岁癌末老妇 2次动手术康复 (97-year-old woman with terminal cancer undergoes two operations and makes recovery)
• 九旬阿嬷大肠癌晚期　不放弃求医动手术康复 (Ninety-year-old grandmother with advanced colon cancer undergoes surgery and recovers after refusing to give up on treatment)
• 九旬阿嬷大肠癌晚期　不放弃求医动手术康复 (Ninety-year-old grandmother with advanced bowel cancer refuses to give up, undergoes surgery and makes recovery)
• 华裔九旬阿嬷大肠癌晚期　不放弃求医动手术康复 (Ninety-year-old Chinese grandmother with advanced colon cancer undergoes surgery and recovers after refusing to give up on treatment)
• 患直腸癌末期不放棄 97歲嬤動2次手術康復 (97-year-old grandmother undergoes two operations and recovers despite terminal rectal cancer)

1. Low, Jia Li & Pang, Angela & Cheng, Joseph & Ng, Alex & Choo, Tai & Shin, Ng & Tey, Jeremy & Francis C H Ho & Chen, Matthew & Kumarakulasinghe, Nesaretnam. (2024). Impact of geriatric assessment and Geriatric 8-based targeted interventions on quality of life in older adults with cancer. Journal of Geriatric Oncology. 16. 102149. 10.1016/j.jgo.2024.102149. (Arti Hurria Award at Annual Meeting for International Society of Geriatric Oncology Meeting 2025)
2. Ng ZX, Handa P, Zheng H, Chen MZ, Soon YY, Blinman P, Stockler M, Francis C H Ho. Health-related quality of life with comprehensive geriatric assessment guided care versus usual care in older adults with cancer: A systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol. 2024 Jul 16;201:104442. doi: 10.1016/j.critrevonc.2024.104442.
3. Francis C H Ho, Alfred Kow, Lim WC, Chen MZ, Mohd Rais NC, Ling NMW, Ooi M, Ng JY, Ng YS, Chun M, Yao Y, Mohd Said N, Eng WN, Chen WM, Luah V, Loy Y, Ong J, Wong WY, Korc-Grodzicki B, Lichtman SM, Angela Pang. Feasibility of a Geriatric Oncology Longitudinal End to End (GOLDEN) Program in a Tertiary Cancer Centre in Singapore. Oncologist. 2023 Feb 13:oyac276. doi: 10.1093/oncolo/oyac276.
4. Pang A, Jiali L, Ng A, Cheng J, Wang M, Ng YS, Yao Y, Chun M, Francis C H Ho, Tey J. Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population. JAMA Netw Open. 2022 Oct 3;5(10):e2237196. doi:10.1001/jamanetworkopen.2022.37196. 
5. Chen M, Mohd Said N, Mohd Rais NC, Francis C H Ho, Ling N, Chun M, Ng YS, Eng WN, Yao Y, Korc-Grodzicki B, Pang A. Remaining Agile in the COVID-19 pandemic healthcare landscape - How we adopted a hybrid telemedicine Geriatric Oncology care model in an academic tertiary cancer center. JGeriatr Oncol. 2022 Apr 13:S1879-4068(22)00080-7. doi: 10.1016/j.jgo.2022.04.006.
6. Pang A, Jiali L, Ng A, Cheng J, Wang M, Ng YS, Yao Y, Chun M, Francis C H Ho, Tey J. Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population. JAMA Netw Open. 2022 Oct 3;5(10):e2237196. doi:
   10.1001/jamanetworkopen.2022.37196.
7. M.Z. Chen, N.C. Rais, J. Tey, N. Ling, Y.S. Ng, M. Chun, N. Mohd Said, W.N. Eng, Francis C H Ho, A. Pang. Performance of Geriatric 8 (G8) Screening Tool in Older Asians with Cancer. Doi:10.1016/S1879-4068(22)00358-7 (BJ Kennedy Best Poster Award at Annual Meeting for International Society of Geriatric Oncology Meeting 2022)\
8. Ng ZX, Zheng H, Chen MZ, Soon YY, Francis C H Ho, Comprehensive Geriatric Assessment guided treatment versus usual care for older adults aged 60 years and above with cancer. Cochrane Database of Systematic Reviews 2021, Issue 10. Art. No.: CD014875. DOI: 10.1002/14651858.CD014875.
9. Wujanto, C., Tey, J., Chia, D., Francis C H Ho., Ooi, K. H., Wong, A. S., et al. (2019). Radical radiotherapy in older patients with muscle invasive bladder cancer. Journal of Geriatric Oncology. http://doi.org/10.1016/j.jgo.2018.10.015

SPARK - An Annual Publication by NCIS

(pages 8 to 12)

NUH Medical Centre
Level 10, Cancer Centre

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