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Supportive Care in Cancer
Published in: Supportive Care in Cancer 2/2018

01-02-2018 | Original Article

Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

Authors: Allison Magnuson, Tatyana Lemelman, Chintan Pandya, Molly Goodman, Marcus Noel, Mohammed Tejani, David Doughtery, William Dale, Arti Hurria, Michelle Janelsins, Feng Vankee Lin, Charles Heckler, Supriya Mohile

Published in: Supportive Care in Cancer | Issue 2/2018

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Abstract

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 pre-determined 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

The 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.
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Metadata
Title
Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study
Authors
Allison Magnuson
Tatyana Lemelman
Chintan Pandya
Molly Goodman
Marcus Noel
Mohammed Tejani
David Doughtery
William Dale
Arti Hurria
Michelle Janelsins
Feng Vankee Lin
Charles Heckler
Supriya Mohile
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 2/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-017-3874-6

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