Implementation of geriatric assessment in oncology settings: A systematic realist review

McKenzie, Gordon; Bullock, Alex F.; Greenley, Sarah; Lind, Michael; Johnson, Miriam J.; Pearson, Mark

doi:10.1016/j.jgo.2020.07.003

Cited by 31 publications

(29 citation statements)

References 95 publications

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“…Using geriatric screening tools such as the G8 could help select patients who benefit the most from full GA and decrease service saturation. 32 When possible, geriatric screening and other GA tools should be integrated to the electronic medical record. Using idle times during visits to perform GA might increase patient and physician acceptability.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Verduzco-Aguirre

Guerra

Culakova

et al. 2022

JCO Global Oncology

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PURPOSE There is limited information regarding the use of the geriatric assessment (GA) for older adults with cancer in developing countries. We aimed to describe geriatric oncology practice among Mexican oncology professionals and to identify barriers and facilitators for the implementation of GA into the routine care of older adults with cancer in Mexico. METHODS We conducted an explanatory sequential mixed-methods study. We administered an online survey to cancer specialists in Mexico about the routine use of GA and barriers for its use. We then conducted online semistructured interviews with survey respondents selected by their use of GA, expanding on barriers and facilitators for performing GA. Descriptive statistical analyses were performed for quantitative data; qualitative data were analyzed inductively through thematic analysis. We developed joint displays to integrate quantitative/qualitative results. RESULTS We obtained 196 survey responses: 37 physicians (18.9%) reported routinely performing a GA. Medical oncologists ( P = .002) and physicians seeing ≤ 10 patients/day ( P = .010) were more likely to use GA. The most frequent barriers for GA use were lack of qualified personnel (49%), limited knowledge (43.9%), and insufficient time (37.2%). In the interviews (n = 22), the limited availability of geriatricians was commonly mentioned. Respondents highlighted the lack of geriatric oncology knowledge among cancer specialists and geriatricians. Saturation of oncology services and a lack of effective referral pathways for GA were also common issues. Facilitators included availability of geriatricians, system/administrative facilitators, presence of a multidisciplinary team, and availability of geriatric oncology education. CONCLUSION The routine use of geriatric oncology principles in Mexico is limited by the availability of qualified personnel and by insufficient knowledge. An educational intervention could improve the implementation of GA in cancer care.

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Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Verduzco-Aguirre

Guerra

Culakova

et al. 2022

JCO Global Oncology

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“…The perceived clinical relevance of the assessments goes in line with results proving the clinical benefit of the CGA [ 50 ], predictive value of the CGA [ 51 ] and tests of PF [ 52 , 53 , 54 ]. However, despite this evidence and international recommendations, implementation of these assessments in oncological settings remains challenging and a systemic approach is needed to address organizational and economic barriers [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Development and Evaluation of a Multimodal Supportive Intervention for Promoting Physical Function in Older Patients with Cancer

Shehu

Roggendorf

Golla

et al. 2022

Cancers

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Physical function (PF) in older patients with cancer may decline during and after oncologic therapy. This study aimed to develop and pilot test an individually tailored unsupervised physical activity (PA) program and dietary recommendations to promote PF in older patients with cancer. Following development and pretest, the intervention was pilot tested to explore feasibility, acceptance, adherence and potential benefit. Patients ≥60 years, with heterogeneous cancer diagnoses, starting outpatient radiotherapy were randomized in two study arms: paper-based vs. video-based instructions. Based on assessments of PF, PA, nutrition, cognition, mental health, social support, HRQOL and personal goals, participants received individual recommendations for PA and nutrition. After 12 weeks of intervention (T1), reassessments were performed. The postal 4-week follow-up questionnaire included PA, nutrition and HRQOL. Participants (n = 24, 14 female, mean age 70 ± 7 years) showed comparable characteristics in both study arms. The majority rated the program as helpful. Facilitators and barriers to PA adherence were collected. Both modes of instructions were appreciated equally. PF (EORTC QLQ-C30) declined slightly (not clinically relevant >10 pts.) at group level T0: 76 ± 16, T1: 68 ± 21, T2: 69 ± 24. The intervention was feasible, well accepted, showing potential benefit for the maintenance of PF during outpatient radiotherapy, and should be further tested in a larger sample.

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“…The CGA is also beneficial in terms of reducing the mortality, disability and institutionalisation of community-dwelling older people, allowing for the preservation of physical function, lower healthcare utilisation and reduced hospitalisations [34,35].…”

Section: Proponents Target Population Recommendationsmentioning

confidence: 99%

“…Although the majority of cancer patients are in the geriatric population [36][37][38], and despite the reported benefits of the CGA in the geriatric oncology setting, the CGA is not universally applied in older patients due to the lack of workforce (primarily of geriatricians); economic, logistical and practical barriers (e.g., time-consuming) [35] and because of the limited appreciation of the value of the CGA by oncologists. Gladman and colleagues (2016) referred to this issue as "a know-gap" as a way to express the uncertainty in adopting the CGA in specific settings, including clinical oncology [39].…”

Section: Proponents Target Population Recommendationsmentioning

confidence: 99%

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Zuccarino

Monacelli

Antognoli

et al. 2022

Cancers

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The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.

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Implementation of geriatric assessment in oncology settings: A systematic realist review

Cited by 31 publications

References 95 publications

Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Development and Evaluation of a Multimodal Supportive Intervention for Promoting Physical Function in Older Patients with Cancer

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

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