1. There were significantly fewer instances of grade 3-5 toxic effects among patients in the intervention group (51%) compared to the usual care group (71%; p=0.0001).
2. Fewer falls and more medication discontinuations were reported among patients who received a tailored geriatric assessment summary and management recommendations.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Age-related conditions, such as disability and geriatric syndromes, are prevalent among elderly cancer patients and may affect treatment decision making. However, few studies have assessed the impact of said conditions, and tailored management, on clinical outcomes. This study aimed to identify the utility of a geriatric assessment intervention to minimize adverse outcomes in old-age cancer patients receiving chemotherapy with high-risks of adverse events. The primary endpoint was the proportion of patients with grade 3-5 toxic effects within three months of treatment initiation. Grading was based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4. According to study results, fewer patients who received intervention (tailored geriatric assessment and management) reported grade 3-5 toxic effects compared to those assigned to usual care (no geriatric assessment or tailored management). Patients in the intervention group also reported fewer falls and more medication discontinuations. This study was strengthened by a randomized-cluster design which included patients from all backgrounds, thus increasing the generalizability of results.
In-depth [randomized-cluster trial]: Between Jul 29, 2014, and Mar 13, 2019, 823 patients were assessed for eligibility from 356 community oncology practice sites across the USA. Included were patients aged ≥70 years with ≥1 geriatric domain impairment (physical performance, functional status, comorbidity, cognition, nutrition, social support, polypharmacy, and psychological status), incurable advanced solid tumor or lymphoma (i.e., stage III or IV), and proficiency in English. Patients in both groups completed the geriatric assessment; however, only patients randomized to the intervention group received a tailored assessment summary with management recommendations provided to the oncologist based on literature review, guidelines, and expert consensus.
Altogether, 718 patients were included in the analysis. Mean patient age among those enrolled was 77.2 years (standard deviation [SD] 5.4) and the mean number of geriatric assessment domain impairments was 4.5 (SD 1.6). The primary outcome of patients with grade 3-5 toxic effects, according to NCI CTCAE, was lower in the intervention group (51%) compared to the usual care group (71%, relative risk [RR] 0.74, 95% CI 0.64-0.86, p=0.0001). Furthermore, fewer falls within 3 months (12% vs. 21%, RR 0.58, 95% CI 0.40-0.84, p=0.0035) and more medication discontinuations (mean adjusted difference 0.14, 95% CI 0.03-0.25, p=0.015) were reported in the intervention group compared to usual care. Overall, findings from this study suggest that utilization of a geriatric assessment with tailored management may help to reduce serious adverse effects of high-risk interventions, such as chemotherapy, among older cancer patients.
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