Geriatric assessment in the management of older patients with cancer – A systematic review (update)

Hamaker, Marije E.; Lund, Cecilia Margareta; Molder, Marthe te; Soubeyran, Pierre; Wildiers, Hans; Huis, Lieke van; Rostoft, Siri

doi:10.1016/j.jgo.2022.04.008

Cited by 96 publications

(92 citation statements)

References 60 publications

(152 reference statements)

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“…Ideally, geriatric screening or assessment before cancer treatment could guide treatment decisions and influence outcomes. 13,14,[35][36][37] Despite CGA occurring mostly after starting cancer treatment, the findings suggest a role for CGA-guided supportive interventions to maintain HRQOL and functioning.…”

Section: Table 1: Baseline Characteristics Of the Intention-to-treat ...mentioning

confidence: 94%

“…11 In geriatric oncology, the term geriatric assessment describes the multidimensional assessment of geriatric domains, with or without intervention planning. 6,9,12,13 Geriatric assessment has been shown to identify age-related vulnerabilities in older people with cancer, facilitate nononcological interventions, and alter the oncological treatment for the benefit of patients. 13,14 The effectiveness of geriatric assessment strategies, which can range from geriatric assessment summaries provided to oncologists to full CGA by multidisciplinary teams or geriatricians, depends on the robustness of the process to optimise cancer treatment and health conditions and on their effectiveness in coordinating health-care services and aged care services using a whole-system approach.…”

Section: Introductionmentioning

confidence: 99%

“…6,9,12,13 Geriatric assessment has been shown to identify age-related vulnerabilities in older people with cancer, facilitate nononcological interventions, and alter the oncological treatment for the benefit of patients. 13,14 The effectiveness of geriatric assessment strategies, which can range from geriatric assessment summaries provided to oncologists to full CGA by multidisciplinary teams or geriatricians, depends on the robustness of the process to optimise cancer treatment and health conditions and on their effectiveness in coordinating health-care services and aged care services using a whole-system approach. 9 Several cancer organisations internationally recommend geriatric assessment in older people with cancer before the initiation of cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

Soo

King²,

Pope³

et al. 2022

The Lancet Healthy Longevity

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Section: Table 1: Baseline Characteristics Of the Intention-to-treat ...mentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

Soo

King²,

Pope³

et al. 2022

The Lancet Healthy Longevity

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“…Almost all the respondents (98.2%) admitted that older adults with cancer require different care than younger patients, and 82.4% of clinicians recognized that ECOG-PS and KPS, used in clinical practice to support treatment decisions, are not enough. These findings are significant because there is increasing evidence that conducting a GA can lead to adaptations in clinical management and improved outcomes for older adults with cancer [ 26 ]. However, only a small percentage of respondents (23.4%) reported using GA and/or geriatric screening tools to assess elderly patients in clinical practice, and surprisingly, 8.1% had never heard of GA.…”

Section: Discussionmentioning

confidence: 99%

“…The incorporation of geriatric evaluation into routine clinical practice is hampered by a number of factors, including a lack of time, a shortage of geriatricians and the absence of a national plan. However, we must not forget that a GA can change oncologic treatment plans, lead to non-oncologic interventions, increase the likelihood that a patient will complete their treatment, minimize the risk of complications and toxicity and improve their physical health and quality of life [ 26 ]. Accordingly, GA must serve as the focal point of any intervention and be used as part of the standard of care for older patients with cancer since it is just as crucial as recommending an oncologic therapy.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Oncology in Portugal: Where We Are and What Comes Next—A Survey of Healthcare Professionals

Marinho

Custódio

2022

Geriatrics

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In keeping with the trend worldwide, in Portugal, more than 60% of newly diagnosed patients with cancer are aged 65 years or older, which makes older adults the most common population seen in an oncology practice. This study’s objectives were to assess geriatric oncology practices in Portugal and investigate medical professionals’ current needs and perceptions on the treatment of elderly cancer patients. Methods: A cross-sectional study was conducted using a web-based survey of healthcare providers treating elderly patients. Results: There were 222 responses: 62.6% of physicians reported the absence of geriatric oncology and/or geriatrics consultations in their institutions, 14.9% had guidelines for the management of older patients with cancer and 4.5% had physicians dedicated to geriatric oncology. The reported use of geriatric assessment tools was 23.4%. Medical oncologists and physicians from medical specialties (p = 0.009) and those practicing in the south of Portugal (p = 0.054) were more likely to use geriatric assessment. Education and training in geriatric oncology was identified by 95.0% of respondents as an unmet need. The inquiries identified that geriatric assessment could be useful to define a therapeutic strategy (85.1%), detect frailty (77.5%), predict toxicity and improve quality of life (73.4%). Conclusions: There is a paucity of expertise and training in geriatric oncology in Portugal but an increasing perception of the value of geriatric assessment and the demand for education. In the next years, Portugal will progress in this area with the aid of the recently created Geriatric Oncology Working Group.

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Rates of and Factors Associated With Patient Withdrawal of Consent in Cancer Clinical Trials

et al. 2023

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ImportancePatient withdrawal of consent from a cancer clinical trial is defined as a patient’s volitional cessation of participation in all matters related to a trial. It can undermine the trial’s purpose, make the original sample size and power calculations irrelevant, introduce bias between trial arms, and prolong the time to trial completion.ObjectiveTo report rates of and baseline factors associated with withdrawal of consent among patients in cancer clinical trials.Design, Setting, and ParticipantsThis multisite observational cohort study was conducted through the Alliance for Clinical Trials in Oncology. Patient withdrawal was defined as a patient’s voluntary termination of consent to participate anytime during trial conduct. Baseline patient- and trial-based factors were investigated for their associations with patient withdrawal within the first 2 years using logistic regression models. All patients who participated in cancer therapeutic clinical trials conducted within the Alliance for Clinical Trials in Oncology from 2013 through 2019 were included. The data lock date was January 23, 2022.Main Outcomes and MeasuresThe percentage of patients who withdrew consent in 2 years and factors associated with withdrawal of consent.ResultsA total of 11 993 patients (median age, 62 years; 67% female) from 58 trials were included. Within 2 years, 1060 patients (9%) withdrew from their respective trials. Two-year rates of withdrawal were 5.7%, 7.6%, 8.5%, 7.8%, 8.4%, 9.5%, and 9.8% for each of the respective years from 2013 through 2019. In multivariable analyses, Hispanic ethnicity (odds ratio [OR], 1.67; 95% CI, 1.30-2.15; P &lt; .001), randomized design with placebo (OR, 1.64; 95% CI, 1.38-1.94; P &lt; .001), and patient age 75 years and older (OR, 1.39; 95% CI, 1.12-1.72; P = .003) were associated with higher likelihood of withdrawal by 2 years. Use of radiation was associated with patient retention (OR, 0.68; 95% CI, 0.54-0.86; P = .001).Conclusions and RelevanceIn this cohort study, rates of withdrawal of consent were less than 10% and appeared consistent over time. Factors that are associated with withdrawal of consent should be considered when designing trials and should be further studied to learn how they can be favorably modified.

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Geriatric assessment in the management of older patients with cancer – A systematic review (update)

Cited by 96 publications

References 60 publications

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

Geriatric Oncology in Portugal: Where We Are and What Comes Next—A Survey of Healthcare Professionals

Rates of and Factors Associated With Patient Withdrawal of Consent in Cancer Clinical Trials

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