Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 years and Older with Non-Metastatic Prostate Cancer? – National Survey

Zereshkian, Arman; Cao, Xingshan; Puts, Martine; Dawdy, Krista; Prospero, Lisa Di; Alibhai, Shabbir M.H.; Neve, Matthew; Szumacher, Ewa

doi:10.1016/j.jgo.2019.01.015

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Almost 50% of radiation oncologists report low levels of confidence in treating complex issues in older adults. [49][50][51] Therefore, it is no surprise that there is wide variability in how radiation oncologists make treatment decisions in older adults. Older adults less often receive guideline-based RT and are more likely to receive deintensified regimens (e.g., fewer sessions or lower RT doses).…”

Section: Disparities In the Care Of Older Adults: A Radiation Oncologist's Perspectivementioning

confidence: 99%

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Dharmarajan

Presley

Wyld

2021

American Society of Clinical Oncology Educational Book

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Older adults comprise a considerable proportion of patients with cancer in the world. Across multiple cancer types, cancer treatment outcomes among older age groups are often inferior to those among younger adults. Cancer care for older individuals is complicated by the need to adapt treatment to baseline health, fitness, and frailty, all of which vary widely within this age group. Rates of social deprivation and socioeconomic disparities are also higher in older adults, with many living on reduced incomes, further compounding health inequality. It is important to recognize and avoid undertreatment and overtreatment of cancer in this age group; however, simply addressing this problem by mandating standard treatment of all would lead to harms resulting from treatment toxicity and futility. However, there is little high-quality evidence on which to base these decisions, because older adults are poorly represented in clinical trials. Clinicians must recognize that simple extrapolation of outcomes from younger age cohorts may not be appropriate because of variance in disease stage and biology, variation in fitness and treatment tolerance, and reduced life expectancy. Older patients may also have different life goals and priorities, with a greater focus on quality of life and less on length of life at any cost. Health care professionals struggle with treatment of older adults with cancer, with high rates of variability in practice between and within countries. This suggests that better national and international recommendations that more fully address the needs of this special patient population are required and that primary research focused on the older age group is urgently required to inform these guidelines.

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Section: Disparities In the Care Of Older Adults: A Radiation Oncologist's Perspectivementioning

confidence: 99%

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Dharmarajan

Presley

Wyld

2021

American Society of Clinical Oncology Educational Book

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“…International medical societies, like the European Organization for Research and Treatment of Cancer (EORTC), European Association of Urology (EAU) and International Society of Geriatric Oncology (SIOG), all recommend screening cancer patients aged ≥ 70 with the G8 since this was proven to identify those requiring a more complex CGA [ 7 ]. Nevertheless, as emerged in recent surveys, up to half of the clinicians use merely the performance status (PS) by Karnofsky (KPS) or Eastern Cooperative Oncology Group (ECOG PS) scores to assess patient’s frailty and select older patients for chemotherapy [ 18 , 19 , 20 ]. Unfortunately, these scores consider physical functioning only, neglecting psychosocial, nutritional and cognitive aspects, which are crucial to evaluating patient’s frailty status [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

The Geriatric G8 Score Is Associated with Survival Outcomes in Older Patients with Advanced Prostate Cancer in the ADHERE Prospective Study of the Meet-URO Network

et al. 2022

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Introduction: Androgen receptor pathway inhibitors (ARPIs) have been increasingly offered to older patients with prostate cancer (PC). However, prognostic factors relevant to their outcome with ARPIs are still little investigated. Methods and Materials: The Meet-URO network ADHERE was a prospective multicentre observational cohort study evaluating and monitoring adherence to ARPIs metastatic castrate-resistant PC (mCRPC) patients aged ≥70. Cox regression univariable and multivariable analyses for radiographic progression-free (rPFS) and overall survival (OS) were performed. Unsupervised median values and literature-based thresholds where available were used as cut-offs for quantitative variables. Results: Overall, 234 patients were enrolled with a median age of 78 years (73–82); 86 were treated with abiraterone (ABI) and 148 with enzalutamide (ENZ). With a median follow-up of 15.4 months (mo.), the median rPFS was 26.0 mo. (95% CI, 22.8–29.3) and OS 48.8 mo. (95% CI, 36.8–60.8). At the MVA, independent prognostic factors for both worse rPFS and OS were Geriatric G8 assessment ≤ 14 (p < 0.001 and p = 0.004) and PSA decline ≥50% (p < 0.001 for both); time to castration resistance ≥ 31 mo. and setting of treatment (i.e., post-ABI/ENZ) for rPFS only (p < 0.001 and p = 0.01, respectively); age ≥78 years for OS only (p = 0.008). Conclusions: Baseline G8 screening is recommended for mCRPC patients aged ≥70 to optimise ARPIs in vulnerable individuals, including early introduction of palliative care.

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“…In a Canadian survey conducted among 44 radiation oncologists, 66% did not use any tools to make treatment decisions for older patients with prostate cancer, indicating obstacles in the lack of knowledge, time, support, and resources. 25 Sixty-nine members of the Medical Oncology Group of Australia pointed out a perceived value in geriatric assessment but the lack of access to geriatric review as the main barrier to geriatric assessment. 26 Low uptake of geriatric assessments or screening tools has been reported by 93 oncologists from the same group, with performance status as the most influential factor in deciding whether or not to prescribe chemotherapy to older patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

International Survey on Frailty Assessment in Patients with Cancer

et al. 2022

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Background Frailty negatively affects the outcomes of patients with cancer, and its assessment might vary widely in the real world. The objective of this study was to explore awareness and use of frailty screening tools among the ONCOassist healthcare professionals (HCPs) users. Materials and Methods We sent 2 emails with a cross-sectional 15-item survey in a 3-week interval between April and May 2021. Differences in the awareness and use of tools according to respondents’ continents, country income, and job types were investigated. Results Seven hundred thirty-seven HCPs from 91 countries (81% physicians, 13% nurses, and 5% other HCPs) completed the survey. Three hundred and eighty-five (52%) reported assessing all or the majority of their patients; 518 (70%) at baseline and before starting a new treatment. Three hundred and four (43%) HCPs were aware of performance status (PS) scores only, 309 (42%) age/frailty/comorbidity (AFC) screening, and 102 (14%) chemotoxicity predictive tools. Five hundred and thirty-seven (73%) reported using tools; 423 (57%) just PS, 237 (32%) AFC, and 60 (8%) chemotoxicity ones. Reasons for tools non-use (485 responders) were awareness (70%), time constraints (28%), and uselessness (2%). There were significant differences in awareness and use of screening tools among different continents, country income, job types, and medical specialties (P < .001 for all comparisons). Conclusion Among selected oncology HCPs, there is still a worldwide lack of knowledge and usage of frailty screening tools, which may differ according to their geography, country income, and education. Targeted initiatives to raise awareness and education are needed to implement frailty assessment in managing patients with cancer.

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Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 years and Older with Non-Metastatic Prostate Cancer? – National Survey

Cited by 11 publications

References 22 publications

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives

The Geriatric G8 Score Is Associated with Survival Outcomes in Older Patients with Advanced Prostate Cancer in the ADHERE Prospective Study of the Meet-URO Network

International Survey on Frailty Assessment in Patients with Cancer

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