# A defined pathway for patients with both dementia and cancer

Source: https://onco.cc/ideas/idea-acc-dementia-and-cancer-pathway/  
OnCo record `idea-acc-dementia-and-cancer-pathway` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People with dementia who develop cancer are often either overtreated or written off, and decisions are made without them. A clear pathway for assessment, consent and treatment planning would improve both.

## Summary

Dementia is common among older cancer patients and complicates diagnosis, capacity assessment, consent, adherence, and toxicity recognition. There is little guidance. A pathway combining cognitive screening at diagnosis, structured capacity assessment, involvement of carers and, where appropriate, advance care planning, simplified regimens, and supported adherence would reduce both undertreatment of those who could benefit and harmful treatment of those who cannot.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Patients with dementia managed through a defined pathway will show higher rates of documented capacity assessment and goal-concordant treatment, and fewer emergency admissions during treatment.
- Rationale: Comorbid dementia is a growing group with no evidence base; pathway approaches have improved care in hip fracture and delirium.
- Proposed test: Develop and pilot the pathway in five centres, measuring documentation of capacity and goals, treatment decisions, and admissions against historical controls.
- Maturity: speculative
- Actor: clinic

## Sources

- Bottleneck evidence (Older and multimorbid patients are excluded and undertreated): Mohile et al., Evaluation of geriatric assessment and management on toxic effects of cancer treatment (GAP70+, Lancet 2021): https://doi.org/10.1016/S0140-6736(21)01789-X

## Connected records

- technologies: [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)

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