Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer

Abstract

Background: Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. Methods: Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients’ palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients’ quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen’s d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. Results: From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (–0.77 vs –3.84; ES = 0.21), reduced number of moderate/severe symptoms (–0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs –0.80; ES = 0.38). Conclusions: In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients’ unique care needs showed encouraging ES estimates for enhancing patients’ QoL, symptom burden, and communication confidence.

Quality of Life as a Mediator between Cancer Stage and Long-Term Mortality in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Radiotherapy

“…The second strategy entails enhancing QoL through specific interventions. Recommended interventions include the provision of swallowing function training and oral health care training to reduce the severity of dysphagia [38,39], the substitution of saliva for mouthwash to reduce xerostomia [40], implementation of regular home nursing interventions to improve global health [41], implementation of nutrition support and head-and-neck rehabilitation exercise to ameliorate fatigue [42], implementation of psychological interventions (particularly cognitive behavioral therapy) to mitigate depression or anxiety [43], and implementation of transdisciplinary geriatric and palliative care interventions to enhance the QoL of older adults with cancer [44].…”

Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment

“…Additionally, older patients frequently suffer from comorbidities, and symptoms of these diseases can be associated with the ones originated by the tumor (including dyspnoea, fatigue or declining of the general condition, among others). 32,33 These coexisting symptoms may also require a therapeutic approach. However, this association was not confirmed in the multivariate analysis, and should be explored in prospective studies.…”

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

“…The International Society of Geriatric Oncology (SIOG) [21,22] Cancer patients aged 70 or older -adoption of CGA with further interventions and follow-up use of screening tools to identify those patients who need CGA and multidisciplinary approach, when facing a busy clinical practice the preferred screening tool may depend on the clinical situation…”

“…Among the identified studies, there were 15 RCTs [58,59,[61][62][63][64][65][66][67][68][69][70][71][72][73], 6 observational cohort studies [74][75][76][77][78][79], 3 before-and-after studies [80][81][82], 2 pilot studies [60,83], 1 descriptive comparison study [84], 1 prospective observational study [85] and 1 secondary analysis study (of RCT) [86].…”