Older patients with cancer experience improved quality of life when they receive a geriatric assessment and when geriatricians are involved in establishing their cancer care plans, according to a new study presented May 13 in advance of the American Society of Clinical Oncology (ASCO) Virtual Scientific Program to be held May 29–31.
The study illuminates the potentially beneficial role of adding physicians who specialize in the health of seniors to cancer care teams.
More than half of all cancer diagnoses in the United States are among people ages 65 and older, according to the American Cancer Society. Cancer in people 85 and older accounts for 8 percent of all cases diagnosed in the United States.
The study is the first randomized clinical trial in geriatric oncology to show that an integrated team approach can improve patient quality of life, reduce hospital admissions, and prevent early discontinuation of treatment due to adverse events.
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Oncogeriatric Care: Attending to the Most Vulnerable Patients
Typically, an older adult with cancer is referred to a geriatrician only in the later stages of the disease, when patients may encounter difficulty functioning at home, said lead author Wee-Kheng Soo, MBBS, a geriatrician and medical oncologist at Eastern Health and Monash University in Melbourne, Australia.
“With the aging global population, oncologists are faced with the challenges of managing the healthcare needs of older cancer patients,” said Dr. Soo.
“Older people with cancer are a vulnerable group … especially when they are receiving treatments with high side effects, such as chemotherapy.”
Geriatricians are trained to conduct a coordinated, person-centered assessment that is useful for complex medical conditions, such as cancer, Soo said. “Geriatricians have a holistic way of assessing the health of an older person,” he said.
“The geriatric assessment focuses on vulnerabilities commonly seen in older people,” such as other healthcare problems, medication management, memory issues, depression, social isolation, and daily functioning abilities,” said Soo.
A comprehensive geriatric assessment can also help identify which cancer treatments an older adult is likely able, or unable, to tolerate.
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Geriatric Cancer Intervention: Improving Care and Quality of Life
The study, dubbed INTEGERATE, looked at 154 patients age 70 or older who were about to begin cancer treatment. The patients were randomized to receive usual cancer care or an intervention that included a geriatric assessment and a geriatrician-led care plan — an approach called integrated oncogeriatric care.
Researchers looked at patient scores on an assessment tool called the Elderly Functional Index as well as another quality-of-life questionnaire.
The study showed that patients who received the geriatric intervention had significantly higher quality-of-life scores at 12, 18, and 24 weeks of follow-up compared with patients who received regular care, as well as having improved function and mobility and less worry compared with the other group.
The geriatric intervention also appeared to impact clinical care. The intervention group patients had 1.3 fewer visits to the emergency department and 1.2 fewer unplanned hospital admissions. The number of overnight hospital stays was 24 percent lower among the intervention group patients. And the proportion of patients who discontinued cancer treatment early due to adverse events was 32.9 percent in the intervention group compared with 53.2 percent in the control group.
Oncogeriatric Care: A Growing Trend
Soo and his colleagues plan to further assess the oncogeriatric model of care in a larger, multicenter trial. But the findings of this one, said Soo, suggest “that all older people 70 years and above with cancer should receive the comprehensive geriatric assessment to optimize their clinical care and help outcomes.”
In the meantime, comprehensive geriatric assessment in cancer care is an idea that is catching on in the United States, said ASCO's chief medical officer and executive vice president Richard L. Schilsky, MD.
The new study, said Dr. Schilsky, “really cements the value of comprehensive geriatric assessment for older individuals.”