Skip to main content
Top
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Study protocol

Role of geriatric intervention in the treatment of older patients with cancer: rationale and design of a phase III multicenter trial

Authors: Pierre Soubeyran, Catherine Terret, Carine Bellera, Franck Bonnetain, Olivier Saint Jean, Angéline Galvin, Camille Chakiba, Marie-Dominique Zwolakowski, Simone Mathoulin-Pélissier, Muriel Rainfray

Published in: BMC Cancer | Issue 1/2016

Login to get access

Abstract

Background

In the general geriatric population, programs linking geriatric evaluation with interventions are effective for improving functional status and survival of the patients. Whether or not these interventions improve health related quality of life (HRQoL) or overall survival (OS) in older patients with cancer is not yet clear. Indeed, randomized data on the effect of such interventions on survival and HRQoL are rare and conflicting. We describe the rationale and design of a phase III multicenter trial aimed at assessing the efficacy of geriatric intervention in the management of elderly patients with cancer.

Methods/design

Approximately 1200 patients, 70 years and older, considered in need of a geriatric intervention based on the G8 screening tool will be randomized into two intervention arms. The ‘Usual-care’ arm involves standard oncological care based on pre-defined oncological protocols. In addition to the standard oncological care, the ‘Case-management’ arm involves a multidimensional geriatric assessment and interventions tailored for the patient. Efficacy will be assessed using a co-primary endpoint encompassing OS and HRQoL.

Discussion

This trial has been designed to assess whether focused geriatric case management can either improve OS or HRQoL in elderly cancer patients considered in need of geriatric assessment.

Trial registration

Clinicaltrials.gov ID: NCT02704832.
Appendix
Available only for authorised users
Literature
1.
go back to reference Extermann M, Green T, Tiffenberg G, Rich C. Validation of the Senior Adult Oncology Program (SAOP) 2 screening questionnaire. Crit Rev Oncol Hematol. 2009;69(2):183–5.CrossRef Extermann M, Green T, Tiffenberg G, Rich C. Validation of the Senior Adult Oncology Program (SAOP) 2 screening questionnaire. Crit Rev Oncol Hematol. 2009;69(2):183–5.CrossRef
2.
go back to reference Hamaker ME, Jonker JM, de Rooij SE, et al. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13(10):e437–44.CrossRefPubMed Hamaker ME, Jonker JM, de Rooij SE, et al. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13(10):e437–44.CrossRefPubMed
3.
go back to reference Soubeyran P, Bellera C, Goyard J, et al. Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study. PLoS One. 2014;9(12):e115060.CrossRefPubMedPubMedCentral Soubeyran P, Bellera C, Goyard J, et al. Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study. PLoS One. 2014;9(12):e115060.CrossRefPubMedPubMedCentral
4.
go back to reference Saliba D, Elliott M, Rubenstein LZ, et al. The vulnerable elders survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49(12):1691–9.CrossRefPubMed Saliba D, Elliott M, Rubenstein LZ, et al. The vulnerable elders survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49(12):1691–9.CrossRefPubMed
5.
go back to reference Bellera CA, Rainfray M, Mathoulin-Pelissier S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23:2166–72.CrossRefPubMed Bellera CA, Rainfray M, Mathoulin-Pelissier S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23:2166–72.CrossRefPubMed
6.
go back to reference Goodwin JS, Satish S, Anderson ET, Nattinger AB, Freeman JL. Effect of nurse case management on the treatment of older women with breast cancer. J Am Geriatr Soc. 2003;51(9):1252–9.CrossRefPubMed Goodwin JS, Satish S, Anderson ET, Nattinger AB, Freeman JL. Effect of nurse case management on the treatment of older women with breast cancer. J Am Geriatr Soc. 2003;51(9):1252–9.CrossRefPubMed
7.
go back to reference Morey MC, Snyder DC, Sloane R, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA. 2009;301(18):1883–91.CrossRefPubMedPubMedCentral Morey MC, Snyder DC, Sloane R, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA. 2009;301(18):1883–91.CrossRefPubMedPubMedCentral
8.
go back to reference Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28(2):340–7.CrossRefPubMed Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28(2):340–7.CrossRefPubMed
9.
go back to reference Demark-Wahnefried W, Clipp EC, Lipkus IM, et al. Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. J Clin Oncol. 2007;25(19):2709–18.CrossRefPubMed Demark-Wahnefried W, Clipp EC, Lipkus IM, et al. Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. J Clin Oncol. 2007;25(19):2709–18.CrossRefPubMed
10.
go back to reference Hempenius L, Slaets JP, Van AD, et al. Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients: report on a multicentre, randomized, controlled trial. PLoS One. 2013;8(6):e64834.CrossRefPubMedPubMedCentral Hempenius L, Slaets JP, Van AD, et al. Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients: report on a multicentre, randomized, controlled trial. PLoS One. 2013;8(6):e64834.CrossRefPubMedPubMedCentral
11.
go back to reference Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984;311(26):1664–70.CrossRefPubMed Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984;311(26):1664–70.CrossRefPubMed
12.
go back to reference Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342(8878):1032–6.CrossRefPubMed Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342(8878):1032–6.CrossRefPubMed
13.
go back to reference Bourdel-Marchasson I, Blanc-Bisson C, Doussau A, et al. Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial. PLoS One. 2014;9(9):e108687.CrossRefPubMedPubMedCentral Bourdel-Marchasson I, Blanc-Bisson C, Doussau A, et al. Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial. PLoS One. 2014;9(9):e108687.CrossRefPubMedPubMedCentral
14.
go back to reference Rao AV, Hsieh F, Feussner JR, Cohen HJ. Geriatric evaluation and management units in the care of the frail elderly cancer patient. J Gerontol A Biol Sci Med Sci. 2005;60(6):798–803.CrossRefPubMed Rao AV, Hsieh F, Feussner JR, Cohen HJ. Geriatric evaluation and management units in the care of the frail elderly cancer patient. J Gerontol A Biol Sci Med Sci. 2005;60(6):798–803.CrossRefPubMed
15.
go back to reference McCorkle R, Strumpf NE, Nuamah IF, et al. A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc. 2000;48(12):1707–13.CrossRefPubMed McCorkle R, Strumpf NE, Nuamah IF, et al. A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc. 2000;48(12):1707–13.CrossRefPubMed
16.
go back to reference Aaronson NK, Ahmedzai S, Bergman B, et al. 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. 1993;85(5):365–76.CrossRefPubMed Aaronson NK, Ahmedzai S, Bergman B, et al. 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. 1993;85(5):365–76.CrossRefPubMed
17.
go back to reference Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A Standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.CrossRefPubMed Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A Standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.CrossRefPubMed
18.
go back to reference Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed
19.
go back to reference Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116–22.CrossRefPubMed Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116–22.CrossRefPubMed
20.
go back to reference Sheikh J, Yesavage JA. Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–71.CrossRef Sheikh J, Yesavage JA. Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–71.CrossRef
21.
go back to reference Johnson C, Fitzsimmons D, Gilbert J, et al. Development of the European Organisation for Research and Treatment of Cancer quality of life questionnaire module for older people with cancer: The EORTC QLQ-ELD15. Eur J Cancer. 2010;46(12):2242–52.CrossRefPubMed Johnson C, Fitzsimmons D, Gilbert J, et al. Development of the European Organisation for Research and Treatment of Cancer quality of life questionnaire module for older people with cancer: The EORTC QLQ-ELD15. Eur J Cancer. 2010;46(12):2242–52.CrossRefPubMed
22.
go back to reference Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil. 1986;67(6):387–9.PubMed Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil. 1986;67(6):387–9.PubMed
23.
go back to reference Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–31.CrossRefPubMed Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–31.CrossRefPubMed
24.
go back to reference Pallis AG, Ring A, Fortpied C, et al. EORTC workshop on clinical trial methodology in older individuals with a diagnosis of solid tumors. Ann Oncol. 2011;22(8):1922–6.CrossRefPubMed Pallis AG, Ring A, Fortpied C, et al. EORTC workshop on clinical trial methodology in older individuals with a diagnosis of solid tumors. Ann Oncol. 2011;22(8):1922–6.CrossRefPubMed
25.
go back to reference Wildiers H, Mauer M, Pallis A, et al. End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer—Alliance for Clinical Trials in Oncology—International Society Of Geriatric Oncology position article. J Clin Oncol. 2013;31(29):3711–8.CrossRefPubMed Wildiers H, Mauer M, Pallis A, et al. End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer—Alliance for Clinical Trials in Oncology—International Society Of Geriatric Oncology position article. J Clin Oncol. 2013;31(29):3711–8.CrossRefPubMed
26.
go back to reference Fayers P, Bottomley A. Quality of life research within the EORTC 2014;the EORTC QLQ-C30. Eur J Cancer;38:125–33. Fayers P, Bottomley A. Quality of life research within the EORTC 2014;the EORTC QLQ-C30. Eur J Cancer;38:125–33.
27.
go back to reference Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–44.PubMed Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–44.PubMed
28.
go back to reference Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.CrossRefPubMed Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.CrossRefPubMed
29.
go back to reference Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86.CrossRefPubMed Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86.CrossRefPubMed
30.
go back to reference Wheelwright S, Darlington AS, Fitzsimmons D, et al. International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer. Br J Cancer. 2013;109(4):852–8.CrossRefPubMedPubMedCentral Wheelwright S, Darlington AS, Fitzsimmons D, et al. International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer. Br J Cancer. 2013;109(4):852–8.CrossRefPubMedPubMedCentral
31.
go back to reference Bonnetain F, Dahan L, Maillard E, et al. Time until definitive quality of life score deterioration as a means of longitudinal analysis for treatment trials in patients with metastatic pancreatic adenocarcinoma. Eur J Cancer. 2010;46(15):2753–62.CrossRefPubMed Bonnetain F, Dahan L, Maillard E, et al. Time until definitive quality of life score deterioration as a means of longitudinal analysis for treatment trials in patients with metastatic pancreatic adenocarcinoma. Eur J Cancer. 2010;46(15):2753–62.CrossRefPubMed
32.
go back to reference Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975;31(1):103–15.CrossRefPubMed Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975;31(1):103–15.CrossRefPubMed
34.
go back to reference Demark-Wahnefried W, Morey MC, Sloane R, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol. 2012;30(19):2354–61.CrossRefPubMedPubMedCentral Demark-Wahnefried W, Morey MC, Sloane R, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol. 2012;30(19):2354–61.CrossRefPubMedPubMedCentral
35.
go back to reference Lapid MI, Rummans TA, Brown PD, et al. Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial. Palliat Support Care. 2007;5(2):107–14.CrossRefPubMed Lapid MI, Rummans TA, Brown PD, et al. Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial. Palliat Support Care. 2007;5(2):107–14.CrossRefPubMed
36.
go back to reference Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346(12):905–12.CrossRefPubMed Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346(12):905–12.CrossRefPubMed
37.
go back to reference Lang PO, Hasso Y, Belmin J, et al. STOPP-START: adaptation of a French language screening tool for detecting inappropriate prescriptions in older people. Can J Public Health. 2009;100(6):426–31.PubMed Lang PO, Hasso Y, Belmin J, et al. STOPP-START: adaptation of a French language screening tool for detecting inappropriate prescriptions in older people. Can J Public Health. 2009;100(6):426–31.PubMed
38.
go back to reference Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.CrossRefPubMed Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.CrossRefPubMed
39.
go back to reference Inouye SK, Bogardus Jr ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–76.CrossRefPubMed Inouye SK, Bogardus Jr ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–76.CrossRefPubMed
40.
go back to reference Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMed Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMed
Metadata
Title
Role of geriatric intervention in the treatment of older patients with cancer: rationale and design of a phase III multicenter trial
Authors
Pierre Soubeyran
Catherine Terret
Carine Bellera
Franck Bonnetain
Olivier Saint Jean
Angéline Galvin
Camille Chakiba
Marie-Dominique Zwolakowski
Simone Mathoulin-Pélissier
Muriel Rainfray
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2927-4

Other articles of this Issue 1/2016

BMC Cancer 1/2016 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine