Geriatric assessment and management improves quality of life for older adults with cancer
Use of comprehensive geriatric assessment and integration of geriatrician-led management into care plans improved health-related quality of life for older adults receiving systemic anticancer therapy, according to results of the prospective, randomized INTEGERATE trial scheduled for presentation during the ASCO20 Virtual Scientific Program.
The approach also decreased hospital admissions and reduced early treatment discontinuation due to adverse events.
The results suggest individuals aged 70 years or older who opt for anticancer therapy should receive comprehensive geriatric assessment and management (CGAM) to optimize outcomes, Wee-Kheng Soo, MBBS, FRACP, medical oncologist and geriatrician at Eastern Health in Australia, and colleagues concluded.
Older adults with cancer often experience significant adverse effects of the malignancy and its treatment due to age-related medical, cognitive, functional, nutritional and psychosocial factors.
CGAM offers a framework for clinicians to conduct a multidimensional, multidisciplinary assessment of an older individual’s physical health, cognition, mental health, functional ability and socioenvironmental circumstances. This allows for a coordinated, person-centered approach toward care, according to study background.
Although the approach has been shown to be effective, lack of evidence from randomized studies has limited uptake of CGAM in oncology.
Soo and colleagues conducted the parallel group, open-label INTEGERATE trial to evaluate the effectiveness of CGAM for adults aged 70 years or older with cancer who were due to receive chemotherapy, immunotherapy or targeted therapy.
Researchers randomly assigned 154 patients 1:1 to integrated oncogeriatric care — which included geriatrician-led CGAM plus usual care — or usual care alone. The study design incorporated minimization to balance cancer type and treatment intent, as well as patient age, sex and performance status.
Soo and colleagues used EORTC questionnaires to assess health-related quality of life at baseline and at 12, 18 and 24 weeks.
Health-related quality of life measured by the validated Elderly Functional Index score served as the primary outcome. Key secondary outcomes included function, mood, health utility, nutrition, treatment delivery, survival and health care utilization.
Thirteen patients (8.4%) died by week 12; most remaining patients (92.2%; n = 130) completed at least two primary outcome assessments.
Results showed patients assigned CGAM plus usual care achieved significantly better Elderly Functional Index scores at all time points than those assigned usual care, with the greatest difference at week 18 (estimated marginal mean score, 72 vs. 58.7; P = .001).
Researchers reported significant differences favoring the intervention group in several aspects of health-related quality of life — including physical, role and social functioning domains, burden of illness, mobility and future worries.
Patients assigned the intervention required 39% fewer visits to the ED (– 1.3 visits per person per year), 43% fewer unplanned hospital admissions (– 1.2 admissions per person per year; P < .001) and 24% fewer overnight stays (– 7 days per person per year).
Patients assigned the intervention also were less likely to require early treatment discontinuation (32.9% vs. 53.2%; P = .01), a trend that appeared due primarily to less treatment-related toxicity.
Soo and colleagues intend to implement an oncogeriatric care model in a large multicenter implementation study to evaluate different geriatric oncology care models — such as oncologist-, nurse- or geriatrician-led — and different care settings, such as radiation oncology, surgical oncology or the inpatient setting. – by Mark Leiser
Reference:
Soo W-K, et al. Abstract 12011. Scheduled for presentation at: ASCO20 Virtual Scientific Program; May 29-31; 2020.
Disclosures: National Health and Medical Research Council in Australia provided funding for this study. Soo reports stock or other ownership interests in Medibank and Sonic Healthcare. Please see the abstract for all other researchers’ relevant financial disclosures.
Perspective
Back to Top
Older adults with cancer may experience increased morbidity from cancer treatments. Comprehensive geriatric assessments have been developed to identify patients who may be at higher risk. However, the use of comprehensive geriatric assessments among older adults with cancer has not been integrated well into cancer care delivery due to lack of randomized data demonstrating efficacy.
Researchers in the INTEGERATE trial randomly assigned patients to an integrated care model using comprehensive geriatric assessments or usual care alone. The comprehensive geriatric assessment and management approach used in this study was associated with improvement in health-related quality of life, unplanned hospital admissions and treatment discontinuation. The integration of comprehensive geriatric assessments should be incorporated more widely into the care of older adults with cancer.
Mount Sinai Health System
Collapse
Soo W-K, et al. Abstract 12011. Scheduled for presentation at: ASCO20 Virtual Scientific Program; May 29-31; 2020.
Read more from ASCO Annual Meeting
View all
Read more about