In-home preventive comprehensive geriatric assessment (CGA) reduces mortality—A randomized controlled trial

Frese, Thomas; Deutsch, Tobias; Keyser, Melanie; Sandholzer, Hagen

doi:10.1016/j.archger.2012.06.012

Cited by 48 publications

(39 citation statements)

References 25 publications

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“…When linked to geriatric-based interventions in non-cancer populations, the GA-guided medical decision-making has been shown to decrease rates of mortality, nursing home admissions, hospitalizations, and assists older adults to maintain better physical and mental function. 34,35 Unfortunately, in patients with cancer, there are limited data to support GA-based interventions in busy oncology clinics. 36 That being said, some of these interventions are simple in nature and are used by many clinicians treating HNSCC and other cancer types already.…”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…It is a multidisciplinary evaluation of an older person, which takes at least physical problems, functional status, cognition, social support and nutrition into consideration . Use of the CGA, provided it is closely linked to a geriatric intervention, has been shown to improve mobility, prevent disability, falls and hospitalization, and to reduce mortality . However, its feasibility in primary care is limited, because it is time‐consuming.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of handgrip strength in people aged 60 years and older: A systematic review and meta‐analysis

Rijk

Roos

Deckx

et al. 2015

Geriatrics Gerontology Int

300

212

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“…12 GA management interventions are utilized frequently by geriatricians in the non-cancer population with the goal to reverse or provide support to areas of impairment identified on GA. An example of a targeted management intervention based upon GA impairment is implementing physical therapy and home safety evaluations for individuals with impaired physical function or falls. GA with targeted management interventions has been studied extensively in the general geriatrics population and have been shown to reduce mortality, 28,31 hospitalizations 32 and functional decline. 31 A Delphi study was conducted of geriatric oncology experts to develop consensus on high-priority GA-based targeted management interventions for older adults with cancer; 35,36 however, to date, no randomized, prospective studies have reported on the feasibility and utility of GA with management interventions in older adults receiving cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

Magnuson

Lemelman

Pandya

et al. 2017

Support Care Cancer

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Background Older adults receiving cancer therapy have heightened risk for treatment-related toxicity. Geriatric Assessment (GA) can identify impairments, which may contribute to vulnerability and adverse outcomes. GA management interventions can address these impairments and have the potential to improve outcomes when implemented. Methods We conducted a randomized pilot study comparing GA with management interventions versus usual care in patients with stage III/IV solid tumor malignancies (N=71). In all patients, a trained coordinator conducted and scored a baseline GA with pre-determined cutoffs for impairment. For patients randomized to the intervention arm, an algorithm was used to identify GA management recommendations based upon identified impairments. Recommendations were relayed to the primary oncologist for implementation. GA was repeated at 3 months. The primary outcome was grade 3-5 chemotherapy toxicity. Secondary outcomes included feasibility, hospitalizations, dose reductions, dose delays and early treatment discontinuation. Results Mean participant age was 76 (70-89). The total number of GA management recommendations relayed was 409, of which 35.4% were implemented by the primary oncologist. Incidence of grade 3-5 chemotherapy toxicity did not differ between the two groups. Prevalence of hospitalization, dose reductions, dose delays, and early treatment discontinuation also did not differ between the two groups. Conclusions An algorithm can be used to guide GA management recommendations in older adults with cancer. However, reliance upon the primary oncologist for execution resulted in a low prevalence of implementation. Future work should aim to understand barriers to implementation and explore alternate models of implementing geriatric-focused care for older adults with cancer.

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In-home preventive comprehensive geriatric assessment (CGA) reduces mortality—A randomized controlled trial

Cited by 48 publications

References 25 publications

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Prognostic value of handgrip strength in people aged 60 years and older: A systematic review and meta‐analysis

Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

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