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01-07-2021 | Geriatric Oncology | Original Article

Impact of care pathway for nursing home residents treated for cancer: ONCO-EHPAD study

Authors: Anne-Laure Couderc, Julie Berbis, Géraldine Delalande, Bénédicte Mugnier, Anais Courcier, Maryline Bourriquen, Dominique Rey, Laurent Greillier, Marjorie Baciuchka, Patrick Sudour, Lauren Agnelli, Emilie Nouguerede, Stéphane Fabries, Patrick Villani

Published in: Supportive Care in Cancer | Issue 7/2021

Abstract

Purpose

Few data are known about cancer management in frail nursing home residents.

Methods

Objective of our prospective, interventional study was to set up in the Marseille area, a care pathway for nursing homes residents with a suspected cancer. It combined cancer diagnosis procedures and comprehensive geriatric assessment (CGA), both made in our geriatric oncology outpatient unit, before oncologic advice for treatment decision. In standard care, CGA is carried out after therapeutic decision, to determine whether the planned treatment is compatible with the patient’s frailties. CGA and quality of life were performed at enrolment and at 6 months. This study was registered in ClinicalTrials.gov (NCT03103659).

Results

Between April 2017 and March 2020, 48 residents from 38 nursing homes were included: 24 had the care pathway (PP), and 24 the standard care (NPP). Six were excluded (no cancer). PP had more frailties than NPP. All PP and 75% of NPP had outpatient care. Curative treatment was given to 77% of NPP (including chemotherapy in 10 cases), and 25% of PP (surgery, radiotherapy, hormone therapy). A majority of PP (75%) had supportive care. At 6 months, 16 patients died (11 NPP, 5 PP). Quality of life evolution was available for 11 PP and 7NPP: it showed stability in PP and degradation in NPP.

Conclusion

Even if part of residents were too frail to get curative treatment, the care pathway enabled them to benefit from oncologic advice and appropriate supportive care while preserving their quality of life. Further investigations are needed to confirm these findings.

Santé Publque france (2015) Projection de l’incidence et de la mortalité par cancer en France métropolitaine en 2015. Rapport technique. https://www.santepubliquefrance.fr/docs/projection-de-l-incidence-et-de-la-mortalite-par-cancer-en-france-metropolitaine-en-2015.-rapport-technique. Accessed 7 Oct 2020

Ferlay J, Colombet M, Soerjomataram I, Dyba T, Randi G, Bettio M, Gavin A, Visser O, Bray F (2018) Cancer incidence and mortality patterns in Europe: estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer 103:356–387. https://doi.org/10.1016/j.ejca.2018.07.005CrossRefPubMed

INCA - Les cancers en France. https://www.e-cancer.fr/ressources/cancers_en_france/. Accessed 7 Oct 2020

Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC, Khorana AA, Klepin HD, Lichtman SM, Mustian KM, Tew WP, Hurria A (2018) Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol 36:2326–2347. https://doi.org/10.1200/JCO.2018.78.8687CrossRefPubMedPubMedCentral

Soubeyran P, Fonck M, Blanc-Bisson C, Blanc JF, Ceccaldi J, Mertens C, Imbert Y, Cany L, Vogt L, Dauba J, Andriamampionona F, Houédé N, Floquet A, Chomy F, Brouste V, Ravaud A, Bellera C, Rainfray M (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 30:1829–1834. https://doi.org/10.1200/JCO.2011.35.7442CrossRefPubMed

Boulahssass R, Mari V, Gonfrier S, Auben F, Rambaud C, Ferrero JM, Turpin JM, Bereder JM, Isabelle B, Mahamat A, Cavaglione G, Saada E, Follana P, Benizri E, Otto J, Delotte J, Benchimol D, Brocker P, Francois E, Guerin O (2014) Predictive factors of early death during 100 days after a comprehensive geriatric assessment in older patients with cancer: a prospective cohort study of 576 patients. JCO 32:9511–9511. https://doi.org/10.1200/jco.2014.32.15_suppl.9511CrossRef

Corre R, Greillier L, Le Caër H et al (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase iii randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol 34:1476–1483. https://doi.org/10.1200/JCO.2015.63.5839CrossRefPubMed

En EHPAD, les résidents les plus dépendants souffrent davantage de pathologies aiguës - Ministère des Solidarités et de la Santé. https://drees.solidarites-sante.gouv.fr/etudes-et-statistiques/publications/etudes-et-resultats/article/en-ehpad-les-residents-les-plus-dependants-souffrent-davantage-de-pathologies. Accessed 7 Oct 2020

Colonna M, Mitton N, Bossard N et al (2015) Total and partial cancer prevalence in the adult French population in 2008. BMC Cancer 15:153. https://doi.org/10.1186/s12885-015-1168-2CrossRefPubMedPubMedCentral

10.

Kanapuru B, Posani K, Muller D, Ershler WB (2008) Decreased cancer prevalence in the nursing home. J Am Geriatr Soc 56:2165–2166. https://doi.org/10.1111/j.1532-5415.2008.01864.xCrossRefPubMedPubMedCentral

11.

Wildiers H, Mauer M, Elseviers M, de Wolf J, Hatse S, Hamaker M, Buntinx F, de Lepeleire J, Uytterschaut G, Falandry C, Tryfonidis K, Janssen-Heijnen M (2019) Cancer events in Belgian nursing home residents: an EORTC prospective cohort study. J Geriatr Oncol 10:805–810. https://doi.org/10.1016/j.jgo.2019.03.005CrossRefPubMed

12.

Bradley CJ, Clement JP, Lin C (2008) Absence of cancer diagnosis and treatment in elderly Medicaid-insured nursing home residents. J Natl Cancer Inst 100:21–31. https://doi.org/10.1093/jnci/djm271CrossRefPubMed

13.

Sørbye LW (2013) Cancer as the cause of death in a nursing home setting. J Geriatr Oncol 4:S95–S96. https://doi.org/10.1016/j.jgo.2013.09.164CrossRef

14.

Hamaker ME, Hamelinck VC, van Munster BC, Bastiaannet E, Smorenburg CH, Achterberg WP, Liefers GJ, de Rooij SE (2012) Nonreferral of nursing home patients with suspected breast cancer. J Am Med Dir Assoc 13:464–469. https://doi.org/10.1016/j.jamda.2012.01.002CrossRefPubMed

15.

Korc-Grodzicki B, Wallace JA, Rodin MB, Bernacki RE (2011) Cancer in long-term care. Clin Geriatr Med 27:301–327. https://doi.org/10.1016/j.cger.2011.03.011CrossRefPubMed

16.

Touchard P, Deniel-Lagadec D, Estivin S et al (2019) Prevalence and management of cancer among nursing home residents aged over 75 of age in Brittany. The JOG 10(3):117–125

17.

Jaendel C, Hanon O (2014) Enquête PUGG 2014 Pratiques et Usages en Gériatrie et en Gérrontologie

18.

Bilan du plan cancer. In: INCA. https://www.e-cancer.fr/ressources/plan-cancer-2014-2019-rapports-aux-francais/. Accessed 7 Oct 2020

19.

Soubeyran P, Bellera C, Goyard J, Heitz D, Curé H, Rousselot H, Albrand G, Servent V, Jean OS, van Praagh I, Kurtz JE, Périn S, Verhaeghe JL, Terret C, Desauw C, Girre V, Mertens C, Mathoulin-Pélissier S, Rainfray M (2014) Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One 9:e115060. https://doi.org/10.1371/journal.pone.0115060CrossRefPubMedPubMedCentral

20.

Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. Index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919CrossRefPubMed

21.

Vellas BJ, Wayne SJ, Romero L, Baumgartner RN, Rubenstein LZ, Garry PJ (1997) One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 45:735–738. https://doi.org/10.1111/j.1532-5415.1997.tb01479.xCrossRefPubMed

22.

Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6CrossRefPubMed

23.

Friedman PJ, Richmond DE, Baskett JJ (1988) A prospective trial of serial gait speed as a measure of rehabilitation in the elderly. Age Ageing 17:227–235. https://doi.org/10.1093/ageing/17.4.227CrossRefPubMed

24.

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:601. https://doi.org/10.1093/ageing/afz046CrossRefPubMedPubMedCentral

25.

Clément JP, Nassif RF, Léger JM, Marchan F (1997) Development and contribution to the validation of a brief French version of the Yesavage Geriatric Depression Scale. L’Encephale 23:91–99PubMed

26.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

27.

Ahmedzai S, Bergman B, Bullinger M et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85. https://doi.org/10.1093/jnci/85.5.365

28.

Wheelwright S, Darlington A-S, Fitzsimmons D et al (2013) International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer. Br J Cancer 109:852–858. https://doi.org/10.1038/bjc.2013.407CrossRefPubMedPubMedCentral

29.

Kazis LE, Anderson JJ, Meenan RF (1989) Effect sizes for interpreting changes in health status. Med Care 27:S178–S189. https://doi.org/10.1097/00005650-198903001-00015CrossRefPubMed

30.

Koroukian SM, Xu F, Beaird H, Diaz M, Murray P, Rose JH (2007) Complexity of care needs and unstaged cancer in elders: a population-based study. Cancer Detect Prev 31:199–206. https://doi.org/10.1016/j.cdp.2007.04.002CrossRefPubMedPubMedCentral

31.

Ismail K, Nussbaum L, Sebastiani P, Andersen S, Perls T, Barzilai N, Milman S (2016) Compression of morbidity is observed across cohorts with exceptional longevity. J Am Geriatr Soc 64:1583–1591. https://doi.org/10.1111/jgs.14222CrossRefPubMedPubMedCentral

32.

Ruiz J, Miller AA, Tooze JA, Crane S, Petty WJ, Gajra A, Klepin HD (2019) Frailty assessment predicts toxicity during first cycle chemotherapy for advanced lung cancer regardless of chronologic age. J Geriatr Oncol 10:48–54. https://doi.org/10.1016/j.jgo.2018.06.007CrossRefPubMed

33.

Aparicio T, Gargot D, Teillet L, Maillard E, Genet D, Cretin J, Locher C, Bouché O, Breysacher G, Seitz JF, Gasmi M, Stefani L, Ramdani M, Lecomte T, Auby D, Faroux R, Bachet JB, Lepère C, Khemissa F, Sobhani I, Boulat O, Mitry E, Jouve JL, FFCD 2001-02 investigators (2017) Geriatric factors analyses from FFCD 2001-02 phase III study of first-line chemotherapy for elderly metastatic colorectal cancer patients. Eur J Cancer 74:98–108. https://doi.org/10.1016/j.ejca.2016.09.029CrossRefPubMed

34.

Neville-Webbe HL, Carser JE, Wong H et al (2013) The impact of a new acute oncology service in acute hospitals: experience from the Clatterbridge Cancer Centre and Merseyside and Cheshire Cancer Network. Clin Med (London, England) 13:565–569. https://doi.org/10.7861/clinmedicine.13-6-565CrossRef

35.

O’Neill CB, Atoria CL, O’Reilly EM, Henman MC, Bach PB, Elkin EB, O’Neill CB, Atoria CL, O’Reilly EM, Henman MC, Bach PB, Elkin EB (2016) ReCAP: hospitalizations in older adults with advanced cancer: the role of chemotherapy. J Oncol Pract 12(151–152):e138–e148. https://doi.org/10.1200/JOP.2015.004812CrossRef

36.

Drageset J, Eide GE, Ranhoff AH (2012) Cancer in nursing homes: characteristics and health-related quality of life among cognitively intact residents with and without cancer. Cancer Nurs 35:295–301. https://doi.org/10.1097/NCC.0b013e31822e7cb8CrossRefPubMed

37.

Villeneuve R, Meillon C, Bergua V, Tabue-Teguo M, Amieva H (2020) Influence of pre-admission factors on quality of life and adaptation in nursing home residents with dementia: the QOL-EHPAD study protocol. BMC Geriatr 20:92. https://doi.org/10.1186/s12877-020-1434-2CrossRefPubMedPubMedCentral

Title: Impact of care pathway for nursing home residents treated for cancer: ONCO-EHPAD study
Authors: Anne-Laure Couderc
Julie Berbis
Géraldine Delalande
Bénédicte Mugnier
Anais Courcier
Maryline Bourriquen
Dominique Rey
Laurent Greillier
Marjorie Baciuchka
Patrick Sudour
Lauren Agnelli
Emilie Nouguerede
Stéphane Fabries
Patrick Villani
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: Geriatric Oncology
Care
Geriatric Oncology
Published in: Supportive Care in Cancer / Issue 7/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-020-05973-1

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Abstract

Purpose

Methods

Results

Conclusion

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