Impact of Geriatric Assessment and Management on Quality of Life, Unplanned Hospitalizations, Toxicity, and Survival for Older Adults With Cancer: The Randomized 5C Trial (original) (raw)
Related papers
Supportive Care in Cancer, 2018
Purpose It is recommended to use comprehensive geriatric assessment (CGA) in clinical oncology practice to improve care for geriatric cancer patients and to identify medical and social issues that may need further intervention. The purpose of this pragmatic pilot study was to evaluate the effectiveness of the Hurria et al. CGA in cancer patients 70 years of age or older undergoing adjuvant chemotherapy, as well as the feasibility of integrating it into a busy clinic practice and the psychosocial impact on these patients. Method Twenty-five patients were recruited. Descriptive analysis was performed via a geriatric assessment questionnaire completed by the participants prior to their first adjuvant chemotherapy treatment and during follow-up, 2 to 6 weeks after last treatment. Additionally, study staff performed a geriatric healthcare assessment at both time points. Results The results of this pilot study show that administration is feasible despite some challenges. Administration of a CGA in a clinic setting presented some logistical issues with regard to time and space available in clinic. Analysis of patient data indicated only minor variations in patient domains from pre-chemo to post-chemo confirming previous research. Participants expressed gratitude for the extra time spent with them at a stressful time in their lives. Conclusion Further information regarding the usefulness of a comprehensive geriatric assessment with regard to improving treatment selection, identifying undetected medical problems, and avoiding toxicity will be obtained if the administration of comprehensive geriatric questionnaires is incorporated into the clinic setting and considered into the allocated time for staff workload.
Supportive Care in Cancer, 2017
Background-Older adults receiving cancer therapy have heightened risk for treatment-related toxicity. Geriatric Assessment (GA) can identify impairments, which may contribute to vulnerability and adverse outcomes. GA management interventions can address these impairments and have the potential to improve outcomes when implemented. Methods-We conducted a randomized pilot study comparing GA with management interventions versus usual care in patients with stage III/IV solid tumor malignancies (N=71). In all patients, a trained coordinator conducted and scored a baseline GA with predetermined cutoffs for impairment. For patients randomized to the intervention arm, an algorithm was used to identify GA management recommendations based upon identified impairments. Recommendations were relayed to the primary oncologist for implementation. GA was repeated at 3 months. The primary outcome was grade 3-5 chemotherapy toxicity. Secondary outcomes included feasibility, hospitalizations, dose reductions, dose delays and early treatment discontinuation. Results-Mean participant age was 76 (70-89). The total number of GA management recommendations relayed was 409, of which 35.4% were implemented by the primary oncologist. Incidence of grade 3-5 chemotherapy toxicity did not differ between the two groups. Prevalence of hospitalization, dose reductions, dose delays, and early treatment discontinuation also did not differ between the two groups. Conclusions-An algorithm can be used to guide GA management recommendations in older adults with cancer. However, reliance upon the primary oncologist for execution resulted in a low prevalence of implementation. Future work should aim to understand barriers to implementation and explore alternate models of implementing geriatric-focused care for older adults with cancer.
Journal of Clinical Oncology, 2014
To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment-related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
BMC Geriatrics
Background Age is considered as one of the most important risk-factor for many types of solid and hematological cancers, as their incidence increases with age in parallel to the ever-growing elderly population. Moreover, cancer incidence is constantly increasing as a consequence of the increase in life expectancy that favors the process of cellular senescence. Geriatric assessment has been increasingly recognized as predictive and prognostic instrument to detect frailty in older adults with cancer. In particular, the G8 score is a simple and reproducible instrument to identify elderly patients who should undergo full geriatric evaluation. Due to their frailty, elderly patients may be often under-treated and a therapeutic choice based also on a comprehensive geriatric assessment (CGA) is recommended. With these premises, we aim to test the impact of the CGA based interventions on the quality of life (QoL) of frail elderly onco-hematological patients, identified by the G8 screening, c...
Comprehensive Geriatric Assessment in the Older Adult with Cancer: A Review
European Urology Focus, 2017
Context: The number of older adults with cancer is expected to increase rapidly in the upcoming decades. Aging is heterogeneous and chronological age is often not reflective of biological age. A comprehensive geriatric assessment (CGA) is an in-depth assessment of multiple domains of health that results in better assessment of a patient's overall health and fitness and allows directed intervention to improve patient outcomes. Objective: To review the value of CGA for older adults with cancer, CGA composition and tools that can be utilized, and the feasibility of including CGA in oncologic practice. Evidence acquisition: The currently available evidence on CGA for older adults with cancer was reviewed. Evidence synthesis: A CGA can highlight unidentified health problems and identify patients at higher risk of mortality, functional decline, surgical complications, chemotherapy intolerance, and chemotherapy toxicity. It has been shown that CGA is feasible in the oncology clinic, but geriatric screening tools may be useful to specifically identify patients who would benefit from a full CGA. Conclusions: CGA is feasible and can identify patients at higher risk of adverse events such as mortality, functional decline, surgical complications, and chemotherapy toxicity. Clinicians should consider incorporating CGA when assessing and caring for older adults with cancer. Patient summary: In this report, we review the benefits of a comprehensive geriatric assessment (CGA), a detailed in-depth assessment that identifies health problems not typically identified during routine assessments, for older adults with cancer. We describe the different domains of the CGA and suggest tools to utilize, as well as ways to incorporate CGA into the cancer care setting.
JCO Oncology Practice
PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who wer...
Cancers, 2022
There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligi...
Comprehensive geriatric assessment in older patients with cancer: Two steps forward?
Journal of Geriatric Oncology, 2013
Multiple organizations, including the International Society of Geriatric Oncology and the National Comprehensive Cancer Network, have recommended that all older adults (usually defined as age 70 or older) with cancer undergo a comprehensive geriatric assessment (CGA) at the time of diagnosis and/or prior to treatment decision-making. 1,2 CGA has three key goals in the oncology setting: