From the Journals

Geriatric assessments improve communication during elderly patient visits

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Cancer care in the elderly is complex

Around half of all cancer cases and 70% of all cancer deaths occur in individuals aged over 65 years; this is a very heterogeneous population with a range of impairments, comorbidities, polypharmacy, geriatric syndromes, and other issues. There is limited evidence to guide management of cancer in this group.

This study provides further support for a worldwide consensus on the importance of incorporating geriatric assessments into oncology practice, although it did not find an improvement in quality of life associated with this. This may be because improved communication doesn’t necessarily translate into implementation of the management recommendations that might have benefited quality of life in these patients. There is a need for multidisciplinary care in the older population, not just at assessment but throughout the entire care pathway.

Laura Biganzoli, MD, and Amelia McCartney, MBBS, are from the “Sandro Pitigliani” medical oncology department, Hospital of Prato (Italy), and Nicolò Matteo Luca Battisti, MD, is from the department of medicine–breast unit, The Royal Marsden National Health Service Foundation Trust, Sutton, England. These comments are adapted from their editorial (JAMA Oncol. 2019 Nov 7. doi: 10.1001/jamaoncol.2019.4708). Dr Battisti declared personal fees and nonfinancial support from the pharmaceutical sector unrelated to the submitted work. No other conflicts of interest were declared.


 

FROM JAMA ONCOLOGY

Integrating geriatric assessments into oncology consultations for older patients with cancer could help address aging-related concerns about their disease and treatment, a study has found.

In a study published in JAMA Oncology, researchers reported the outcomes of a cluster-randomized clinical trial involving 541 cancer patients aged 70 years and older, from 31 community oncology practices.

The trial examined the effects of an intervention in which the patient’s oncologist was provided with a geriatric assessment summary of that patient’s age-related impairments, and guided recommendations on how to manage these.

“As an example, the summary would include information that a patient recently fell, that falls increase the risk of chemotherapy toxic effects, and a recommendation for physical therapy to prevent falls,” wrote Supriya G. Mohile, MD, of the University of Rochester (N.Y.), and coauthors. The usual care control arm provided oncologists with alerts only if their patients had scored abnormally on depression and cognitive tests.

The study found that over 6 months, patients in the intervention group reported significantly greater satisfaction with communication about aging-related concerns and greater satisfaction with their overall care.

The intervention group had an adjusted mean of 8.02 conversations about aging-related concerns compared with 4.43 conversations in the usual care group, and an adjusted mean of 4.6 high-quality conversations compared with 2.59 in the usual care group. There were also significantly more conversations about the assessment recommendations in the intervention group compared with the usual care group.

There were no significant differences between the two groups in health-related quality of life for patients or their caregivers. However, caregivers in the intervention group did report significantly greater satisfaction with communication about aging-related concerns and the patient’s condition. They also reported significantly greater satisfaction with their own communications with oncologists about overall care.

“Evidence increasingly supports the use of GA for evaluation and management of older patients with cancer to guide shared decision-making between older patients, caregivers, and oncologists,” the authors wrote. “Despite patient and caregiver concerns and preferences for maintaining function and cognition, oncologists often do not discuss implications of aging-related conditions or inform older patients and caregivers of heightened risk of adverse events from treatment.”

Overall, 90% of patients had at least three geriatric assessment domain impairments; 93.7% had impairments in physical performance, 25.1% reported impairments in psychological status, and 33.3% had possible cognitive impairments.

“These patients represent less-fit individuals for whom there is limited evidence for the risks and benefits of cancer treatment, yet these patients are commonly seen in real-world community practices,” the authors wrote.

The study was supported by funding and individual research grants from the Patient-Centered Outcomes Research Institute, the University of Rochester, the National Institute of Aging, and the National Cancer Institute. Two authors also declared funding from the pharmaceutical sector outside the study.

SOURCE: Mohile S et al. JAMA Oncol. 2019 Nov 7. doi: 10.1001/jamaoncol.2019.4728.

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