Models of Care in Geriatric Oncology

Chapman, Andrew E.; Elias, Rawad; Plotkin, Elana; Lowenstein, Lisa M.; Swartz, Kristine

doi:10.1200/jco.21.00118

Cited by 27 publications

(23 citation statements)

References 54 publications

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“…Although the shared care model embedded in the INTEGERATE study might be advantageous in settings in which geriatrician involvement is available in order to ensure continuity of care throughout the disease trajectory (before, during, and after anticancer therapy), one size does not fit all. 9 More research is needed on the feasibility and applicability of consultative, shared-care and comprehensive models in different care settings (eg, cancer centres, academic hospitals, or community hospitals).…”

Section: Integrating What Matters To Patients In the Care Of Older Ad...mentioning

confidence: 99%

Integrating what matters to patients in the care of older adults with cancer

Murphy¹,

Battisti²

2022

The Lancet Healthy Longevity

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Section: Integrating What Matters To Patients In the Care Of Older Ad...mentioning

confidence: 99%

Integrating what matters to patients in the care of older adults with cancer

Murphy¹,

Battisti²

2022

The Lancet Healthy Longevity

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“…Despite this, GA has not been routinely implemented into clinical practice, and lack of resources in terms of knowledge, time, and trained staff have been recognized as important barriers [15,16]. The use of a geriatric screening tool to select patients in need of a more thorough GA can be a pragmatic approach to this challenge [16][17][18]. Among several tools developed, the Geriatric-8 (G8) questionnaire [19] is currently the most frequently used and best validated in geriatric oncology [18,20].…”

Section: Introductionmentioning

confidence: 99%

Edmonton Frail Scale predicts mortality in older patients with cancer undergoing radiotherapy—A prospective observational study

et al. 2023

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Background Several screening tools are developed to identify frailty in the increasing number of older patients with cancer. Edmonton Frail Scale (EFS) performs well in geriatric settings but is less studied in oncology. We aimed to investigate if EFS score (continuous and categorical) predicts survival in patients referred for radiotherapy, and to assess the concurrent validity of EFS compared with a modified geriatric assessment (mGA). Methods Prospective observational, single-center study including patients ≥65 years, referred for curative or palliative radiotherapy for confirmed cancer. Patients underwent mGA (assessment of cognition, mobility, falls, comorbidity, polypharmacy, depression, nutrition, and activities of daily living) and screening with EFS prior to radiotherapy. The predictive value of EFS score of two-year overall survival (OS) was assessed by Kaplan-Meier plots and compared by log-rank test. Cox proportional hazards regression model was estimated to adjust the associations for major cancer-related factors. Concurrent validity of EFS in relation to mGA was estimated by Spearman`s correlation coefficient and ordinal regression. Sensitivity and specificity for different cut-offs was assessed. Results Patients’ (n = 301) mean age was 73.6 (SD 6.3) years, 159 (52.8%) were men, 54% received curative-intent treatment, breast cancer (32%) was the most prevalent diagnosis. According to EFS≥6, 101 (33.7%) were classified as frail. EFS score was predictive of OS [hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10–1.30)], as was increasing severity assessed by categorical EFS (p<0.001). There was a strong correlation between EFS score and number of geriatric impairments (Spearman`s correlation coefficient 0.77). EFS cut-off ≥6 had a sensitivity of 0.97 and specificity of 0.57 for identifying patients with minimum two geriatric impairments. Conclusion EFS predicts mortality in older patients with cancer receiving radiotherapy, and it is a quick (<5 minutes) and sensitive screening tool to identify patients who may benefit from a geriatric assessment.

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“…Given that the provision of care for older adults with cancer presents the unique challenge of requiring expertise in both oncologic and geriatric issues, most cancer programs are still lacking in terms of meeting the complex needs of these patients. 2 , 3 Consequently, in recent years, there has been an increasing urgency to address that through training and subsequently, the introduction of dedicated geriatric oncologic models of care delivery. 2-4…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a Geriatric Oncology Longitudinal End to End (GOLDEN) Program in a Tertiary Cancer Center in Singapore

Kow

Lim

et al. 2023

The Oncologist

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Introduction In the National University Cancer Institute, Singapore (NCIS), 2 pilot programs providing (i) surgical prehabilitation before cancer surgery and (ii) geriatric oncology support for older adults planned for chemotherapy and/or radiotherapy were merged to form the Geriatric Oncology Longitudinal End to eNd (GOLDEN) program in 2019 to support patients from the time of their cancer diagnosis, through their treatment process, to cancer survivorship. Methods and Materials Older adults aged ≥65 years were enrolled in either surgical prehabilitation, the geriatric medical oncology (GO) arm, or both. All patients undergo a geriatric assessment. We assessed if patients had a change in treatment plans based on GOLDEN recommendations, and the impact on patient related outcomes. Results There were 777 patients enrolled in the GOLDEN program over 2 years; 569 (73%) were enrolled in surgical prehabilitation, 308 (40%) were enrolled in the GO arm, with 100 (12.8%) enrolled in both. 56.9% were females. Median age was 73. Lower gastrointestinal (51.2%) and hepatobiliary cancers (24.1%) were the most common cancer types. 43.4% were pre-frail and 11.7% were frail. Of the 308 patients in the GO arm, 86.0% had geriatric syndromes, while 60.7% had a change in their treatment plans based on GOLDEN recommendations. 31.5% reported an improved global health status, while 38.3% maintained their global health status. 226 (73%) responded that they had benefited from the GOLDEN. Conclusion More than half of the population was either pre-frail or frail. Amongst those in the GO arm, the majority had geriatric syndromes and had a change in their treatment plans based on GOLDEN recommendations. Majority reported either improvement or maintenance in global health status, with most feeling they have benefited from the program. Further evaluation of the longitudinal geriatric hematology-oncology program for cancer-related outcomes and sustainability should be carried out.

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Models of Care in Geriatric Oncology

Cited by 27 publications

References 54 publications

Integrating what matters to patients in the care of older adults with cancer

Integrating what matters to patients in the care of older adults with cancer

Edmonton Frail Scale predicts mortality in older patients with cancer undergoing radiotherapy—A prospective observational study

Feasibility of a Geriatric Oncology Longitudinal End to End (GOLDEN) Program in a Tertiary Cancer Center in Singapore

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