How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study

Festen, Suzanne; Kok, Maaike; Hopstaken, Jana S.; Wal-Huisman, Hanneke van der; Leest, A. Van Der; Reyners, Anna K.L.; Bock, Geertruida H. de; Graeff, Pauline de; Leeuwen, Barbara L. van

doi:10.1016/j.jgo.2019.04.006

Cited by 61 publications

(62 citation statements)

References 51 publications

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“…A comprehensive geriatric assessment of older patients with cancer prior to oncologic decision-making can help clinicians detect previously unidentified health problems and provide the foundation for a treatment regimen specific to the needs of the patient. 58 Among predisposing factors, age at cancer diagnosis was significantly associated with receipt of guideline-concordant treatment. Increasing age was a significant predictor of nonreceipt of guidelineconcordant treatment in the multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Guideline-Concordant Treatment Among Elderly Women With HER2-Positive Metastatic Breast Cancer in the United States

Vyas

Aroke

Kogut

2020

Journal of the National Comprehensive Cancer Network

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Background: It is crucial to identify whether women with HER2positive (HER21) metastatic breast cancer (MBC) are treated according to treatment guidelines and whether treatment disparities exist. This study examined guideline-concordant treatment among women with HER21 MBC and determined the magnitude of differences in treatment between those with positive and negative hormone receptor (HR) status using a nonlinear decomposition technique. Methods: A retrospective observational cohort study was conducted using the SEER-Medicare linked database. The study cohort consisted of women aged $66 years diagnosed with HER21 MBC in 2010 through 2013 (n5241). Guideline-concordant initial treatment after cancer diagnosis was defined based on the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer. A multivariable logistic regression was performed to identify significant predictors of guideline-concordant treatment. A postregression decomposition was conducted to identify the magnitude of disparities in treatment by HR status. Results: Of 241 women included in the study, a total of 76.8% received guideline-concordant treatment. These women were significantly more likely to have positive HR status (P5.0298), have good performance status (P5.0009), and more oncology visits (P,.0001). With 1-year increments in age at cancer diagnosis, the likelihood of receiving guideline-concordant treatment reduced by 5% (P5.0356). The decomposition analysis revealed that 19.0% of the disparity in guideline-concordant treatment between women with positive and negative HR status was explained by differences in their characteristics. Enabling characteristics (marital status, income, and education) explained the highest (22.8%) proportion of the disparity. Conclusions: Nearly one-quarter of the study cohort did not receive guideline-concordant treatment. Our findings suggest opportunities to improve cancer care for elderly women with negative HR status who are unpartnered or have lower socioeconomic status. The high unexplained portion of the disparity by HR status can be due to patient treatment preferences, propensity to seek care, and organizational and physician-level characteristics that were not included in the study.

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Section: Discussionmentioning

confidence: 99%

Guideline-Concordant Treatment Among Elderly Women With HER2-Positive Metastatic Breast Cancer in the United States

Vyas

Aroke

Kogut

2020

Journal of the National Comprehensive Cancer Network

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“…It had no effect on their cancer care, which is a missed opportunity. It is important to note that a potential significant benefit of this assessment is its use before deciding on a cancer care plan to best tailor treatment to the elderly ( 48 ). Second, PET-CT is not part of the standard work-up or staging, as this examination is too expensive for most of our patients and is not covered by insurance in our country, which might bring the accuracy of the staging and evaluation of tumor response in this study into question.…”

Section: Discussionmentioning

confidence: 99%

S-1–Based Chemoradiotherapy Followed by Consolidation Chemotherapy With S-1 in Elderly Patients With Esophageal Squamous Cell Carcinoma: A Multicenter Phase II Trial

Wang

et al. 2020

Front. Oncol.

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Introduction: Intensive treatments can often not be administered to elderly patients with esophageal squamous cell carcinoma (ESCC), leading to a poorer prognosis. This multi-center phase II trial aimed to determine the toxicity profile and efficiency of S-1–based simultaneous integrated boost radiotherapy (SIB-RT) followed by consolidation chemotherapy with S-1 in elderly ESCC patients and to evaluate the usefulness of comprehensive geriatric assessment (CGA). Patients and Methods: We prospectively enrolled 46 elderly patients (age ≥ 70 years) with histopathologically proven ESCC. The patients underwent pretreatment CGA followed by SIB-RT (dose, 59.92 Gy/50.4 Gy) in 28 daily fractions administered using intensity-modulated radiotherapy or volumetric-modulated arc therapy. S-1 was orally administered (40–60 mg/m 2 ) concurrently with radiotherapy and 4–8 weeks later, for up to four 3-week cycles at the same dose. Results: The median survival time was 22.6 months. The 1- and 2-year overall survival rates were 80.4 and 47.8%, respectively. The overall response rate was 78.3% (36/46). The incidence of grade 3–4 toxicities was 28% (13/46). The most common grade 3–4 toxicities were radiation esophagitis (5/46, 10.9%), nausea (4/46, 8.7%), anorexia (3/46, 6.5%), and radiation pneumonitis (3/46, 6.5%). There were no grade 5 toxicities. CGA identified that 48.8% of patients were at risk for depression and 65.5% had malnutrition. Conclusion: Concurrent S-1 treatment with SIB-RT followed by 4 cycles of S-1 monotherapy yielded satisfactory tumor response rates and manageable toxicities in selected elderly patients with ESCC. Pretreatment CGA uncovered numerous health problems and allowed the provision of appropriate supportive care. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT02979691.

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“…A CGA can detect previously unidentified problems in approximately 70% of patients [32], which can impact cancer treatment [19] and provide the foundation for a treatment plan to address malignant and nonmalignant conditions [33]. CGA is used to develop and refine a cancer management plan specific to the needs of the person diagnosed with cancer [20]. A prime goal of geriatric oncology is helping an older person achieve the best health possible while receiving cancer care to maintain independence [4].…”

Section: Defining a Comprehensive Geriatric Assessmentmentioning

confidence: 99%

“…Whatever the size, an MDT functions symbiotically to assess, manage, and monitor many limitations and complications associated with aging and deconditioning [66]. Geriatric oncology has adopted the MDT approach to improve or maintain independence [67] and to provide CGA by which to impact the cancer management plan [20]. Key to an effective MDT are communication, collaboration, and coordination [68].…”

Section: Multidisciplinary Teammentioning

confidence: 99%

“…Many healthcare settings do not use CGA also because of time constraints, availability of a multidisciplinary team, and lack of professionals trained in geriatrics/gerontology. Conducting a CGA is feasible in ambulatory geriatric oncology programs (AGOPs) [10,17] including radiation therapy and surgical oncology [18,19,20]. There are strategies to reduce the time and resources often required to conduct a CGA.…”

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confidence: 99%

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Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer

et al. 2019

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The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.

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How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study

Cited by 61 publications

References 51 publications

Guideline-Concordant Treatment Among Elderly Women With HER2-Positive Metastatic Breast Cancer in the United States

Guideline-Concordant Treatment Among Elderly Women With HER2-Positive Metastatic Breast Cancer in the United States

S-1–Based Chemoradiotherapy Followed by Consolidation Chemotherapy With S-1 in Elderly Patients With Esophageal Squamous Cell Carcinoma: A Multicenter Phase II Trial

Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer

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