Feasibility of geriatric assessment in community oncology clinics

Williams, Grant R.; Deal, Allison M.; Jolly, Trevor A.; Alston, Shani; Gordon, Brittaney Belle E.; Dixon, Samara Ann; Olajide, Oludamilola; Taylor, W. Chris; Messino, Michael J.; Muss, Hyman B.

doi:10.1016/j.jgo.2014.03.001

Cited by 100 publications

(78 citation statements)

References 30 publications

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“…We found that no more than 17% of older patients with cancer who experienced falls had appropriate medical record documentation or referrals. Because oncology providers did not have access to findings from the GA, this study demon- Self-reported KPS, %* 100, normal 28 (22) 90, carry on normal activity 29 (23) 80, normal activity with effort 24 (19) 70, care of self 9 (7) 60, require occasional assistance 28 (22) 50, require considerable assistance 5 (4) 2 (2) 40, disabled strates that oncology providers do not routinely document the presence of falls in older patients with cancer. In the absence of documentation of falls in the medical record, it is likely that older patients who fall are going unrecognized by oncology providers.…”

Section: Discussionmentioning

confidence: 99%

Falls in Older Adults With Cancer: Evaluation by Oncology Providers

Guerard¹,

Deal²,

Williams³

et al. 2015

JOP

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Purpose: Falls in older adults are common. Screening for falls is quick, simple, and important because falls increase the risk of morbidity and mortality in older patients with cancer. The aim of this study was to evaluate oncology providers' recognition of and response to falls in older patients with cancer. Materials and Methods: From a sample of older patientswith cancer who completed a geriatric assessment blinded to oncology providers, we identified patients who self-reported falls within the past 6 months. Their history and physical and/or clinic notes completed by an oncology provider were reviewed for the following: documentation of falls, gait assessment, referral to geriatrics or physical and/or occupational therapy, and measurement of 25-hydroxy vitamin D level.Results: In our sample of older patients with cancer who reported at least one recent fall (N ϭ 125), the average age was 72 years (range, 65 to 93 years), 78% were female, and 62% had a breast cancer diagnosis. Chart reviews showed that 13 (10%) had falls documented, 25 (20%) had a gait assessment, eight (6%) were referred, and 21 (17%) had vitamin D level measured. Conclusion:We found that only 10% of older patients with cancer who self-reported a recent fall had appropriate medical record documentation. Oncologists are often the primary care providers for older patients and are largely unfamiliar with the frequency and impact of falls in this population. There is a need to increase awareness of falls prevalence and consequences among oncology providers in order to provide timely interventions to reduce the risks associated with falls.

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Section: Discussionmentioning

confidence: 99%

Falls in Older Adults With Cancer: Evaluation by Oncology Providers

Guerard¹,

Deal²,

Williams³

et al. 2015

JOP

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“…Participant registry data was linked to a billing claims database (Carolina Data Warehouse [CDW]), to determine the use of OT/PT in inpatient and outpatient settings. (32). …”

Section: Methodsmentioning

confidence: 99%

“…The primary outcome of OT/PT related functional deficit status was defined based on scores within the GA and included at least one of following: any fall within 6 months, any limitation on the IADL and physical health assessment or social activities scale (39-41, 45) a score of 14 seconds or longer on the TUG (27, 32, 37, 38), and/or a score of 11 or greater on the BOMC (33, 46). Need for OT/PT was defined as at least one functional deficit.…”

Section: Methodsmentioning

confidence: 99%

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The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

Pergolotti

Deal

Lavery

et al. 2015

Journal of Geriatric Oncology

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Background Occupational and physical therapy (OT/PT) services seek to reduce morbidity, mortality, and improve the quality of life of individuals; however, little is known about the needs and use of OT/PT for older adults with cancer. The goal of this study was to describe the functional deficits and their associations with other factors, and to examine the use of OT/PT after a noted functional deficit. Materials and Methods This study analyzed data from an institution-based registry that included geriatric assessments of older adults with cancer linked to billing claims data. Logistic regression was used to model predictors of functional deficits. Use of OT/PT was determined and validated with medical chart review. Results 529 patients with cancer, a median age of 71, 78% were female, 87% Caucasian, 57% married, 53% post-secondary education, 63% with breast cancer were included. In a multivariable model, the odds of having any functional deficits increased with age [5 year OR: 1.31, 95% CI: (1.10, 1.57)] were higher for those with a high school diploma versus those with advanced degrees [OR: 1.66, 95% CI: (1.00, 2.77)] and were higher for patients with comorbidities [OR: 1.15, 95% CI: (1.10, 1.21)]. Of patients with functional deficits only 9% (10/111) received OT/PT within 12 months of a noted deficit. Discussion The odds of having any potentially modifiable functional deficit were higher in patients with increasing age, comorbid conditions, and with less than a college degree. Few were referred for OT/PT services suggesting major underutilization of these potentially beneficial services.

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“…41 Falls and cognitive impairment are associated with chemotherapy toxicity in older patients. 5,26 Although GA has demonstrated feasibility in the clinical oncology setting, 42–45 oncologists have been slow to adopt GA, which may reflect lack of knowledge, training, and systematic barriers.…”

Section: Discussionmentioning

confidence: 99%

Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer

Mohile

Magnuson

Pandya

et al. 2018

J Natl Compr Canc Netw

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Background This study’s objectives were to describe community oncologists’ beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods Community oncologists were recruited to participate in two multi-site geriatric oncology trials. Participants shared their beliefs about and confidence with caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs. single-agent vs. no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly-chosen vignette that varied on three variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist and vignette-patient characteristics with treatment decisions. Results Oncologist response rate was 61% (n=305/498). The majority of oncologists agreed that “the care of older adults with cancer needs to be improved” (89%) and that “geriatrics training is essential” (72%). However, less than 25% were “very confident” in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment (GA) in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted OR: 5.01; 95% CI: 2.73–9.20), normal cognition (5.42; 3.01–9.76), and being functionally intact (3.85; 2.12–7.00). Accounting for all vignettes across all scenarios, 161 (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: 3.22; 1.43–7.25; impaired cognition: 3.13, 1.36–7.20; impaired function: 2.48; 1.12 –5.72). Oncologists’ characteristics were not associated with decisions about providing chemotherapy. Conclusion Geriatric-relevant information, when available, strongly influences community oncologists’ treatment decisions.

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Feasibility of geriatric assessment in community oncology clinics

Cited by 100 publications

References 30 publications

Falls in Older Adults With Cancer: Evaluation by Oncology Providers

Falls in Older Adults With Cancer: Evaluation by Oncology Providers

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer

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