Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.

Abstract

12011 Background: Older people experience significant adverse effects of cancer and anti-cancer therapy due to age-related vulnerabilities, including medical, functional, cognitive, nutritional and psychosocial issues. Comprehensive geriatric assessment and management (CGAM) provides a powerful framework to assess an older person’s health status and offers a coordinated, person-centered approach to care. Despite its effectiveness, the uptake of CGAM in oncology has been limited due to a lack of randomized evidence in this setting. This study evaluated the effectiveness of CGAM in older people with cancer. Methods: INTEGERATE is a prospective, randomized, parallel group, open-label study in patients aged >70 years with cancer planned for chemotherapy, targeted therapy or immunotherapy. Patients were randomly assigned (1:1) to receive either geriatrician-led CGAM integrated with usual care (integrated oncogeriatric care) or usual care alone, using minimization to balance treatment intent, cancer type, age, sex and performance status. Health-related quality of life (HRQOL) was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-ELD14 at 0, 12, 18 and 24 weeks. The primary outcome was HRQOL measured by the validated Elderly Functional Index (ELFI) score. Major secondary outcomes included function, mood, nutrition, health utility, treatment delivery, healthcare utilization and survival. Results: Of the 154 patients who underwent randomization, 13 died by week 12 and 130 (92.2% of the remaining patients) completed at least two primary outcome assessments. For the primary outcome, patients in the intervention group had significantly better ELFI score than the usual care group across all followup timepoints, with a maximal difference at week 18 (estimated marginal mean ELFI score 72.0 vs 58.7, p= 0.001). In addition, significant differences favoring the intervention group over the usual care group were seen in HRQOL (domains: physical, role and social functioning; mobility, burden of illness and future worries), unplanned hospital admissions (-1.2 admissions per person-years, p< 0.001) and early treatment discontinuation (32.9% vs 53.2%, p = 0.01). Conclusions: Integrated oncogeriatric care led to improvements in HRQOL, unplanned hospital admissions and treatment discontinuation in older people receiving systemic anti-cancer therapy. Older people (>70 years) planned for anti-cancer therapy should receive CGAM to optimize their clinical care and health outcomes. Clinical trial information: ACTRN12614000399695 .

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

“…A comprehensive geriatric assessment can help achieve the required balance between treatment benefits and side-effects and is recommended by guidelines from the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the International Society for Geriatric Oncology [ 28 , 40 ]. In a randomised study, integrated oncogeriatric care has recently been shown to improve QoL in older patients with cancer being considered for systemic anticancer therapy [ 41 ]. Of particular interest was our finding that in patients ≥80 the negative impact on QoL does not resolve, which suggests a lack of resilience in this cohort.…”

ASCO 2020: The Geriatric Assessment Comes of Age

“…Although GA‐guided interventions are effective for improving survival and functional status in several scenarios [2], there is a lack of information regarding the effects of GA‐guided care on traditional “hard” oncological outcomes, such as overall survival (OS), treatment toxicity, or quality of life (QoL) [3]. Fortunately, four randomized clinical trials (RCT) presented at the 2020 ASCO Annual Meeting have provided new evidence showing that the implementation of GA‐guided interventions for older adults with cancer can in fact lead to improvements in QoL and decreased treatment toxicity, without compromising survival (Table 1) [ 4–6]. These RCTs represent a giant leap forward for geriatric oncology, because they provide a strong foundation that will allow for GA‐guided interventions to become the standard of care for all older adults with cancer.…”

“…The third trial was INTEGERATE, which investigated the effect of geriatrician‐oncologist comanagement on the QoL of older adults with solid tumors or lymphoma starting a new treatment line (including targeted therapy) [6]. Patients aged ≥70 years treated at three Australian hospitals were randomized in a 1:1 fashion to an integrated onco‐geriatric care intervention or to usual care.…”

Developing an electronic geriatric assessment to improve care of older adults with cancer receiving radiotherapy

“…Until recently, no randomized trial had yet to demonstrate that GA-guided care interventions definitively improve outcomes in older adults with cancer, despite these interventions improving outcomes in older non-cancer populations [45] . However, at the 2020 ASCO virtual meeting, 3 randomized trials were presented and demonstrated GA-based interventions helped improve quality of life and toxicity rates among older adults receiving systemic therapy without decreasing expected survival [27] , [46] , [47] . Additionally, to help clinicians better identify frailty, a frailty index (scoring system) generated from the results of GA has been designed that is predictive of all-cause mortality, reduced health-related quality of life, and hospitalizations [48] , [49] , [50] .…”