The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people

Abstract

Background:Although comorbidities are identified in routine oncology practice, intervention plans for the coexisting needs of older people receiving chemotherapy are rarely made. This study evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer.Methods:Comparative study of two cohorts of older patients (aged 70+ years) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010–July 2012) received standard oncology care. The intervention group (N=65, September 2011–February 2013) underwent risk stratification using a patient-completed screening questionnaire and high-risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions.Results:Intervention participants undergoing CGA received mean of 6.2±2.6 (range 0–15) CGA intervention plans each. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI: 1.50–11.42), P=0.006) and fewer required treatment modifications (OR 0.34 (95% CI: 0.16–0.73), P=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group and 52.9% in the control (P=0.292).Conclusions:Geriatrician-led CGA interventions were associated with improved chemotherapy tolerance. Standard oncology care should shift towards modifying coexisting conditions to optimise chemotherapy outcomes for older people.

The impact of age on complications, survival, and cause of death following colon cancer surgery.

“…As aforementioned, CGA and involvement of geriatricians in postoperative care for selected patients may help lower postoperative complication rates and length of stay (Huddleston et al, 2004;Partridge et al, 2014). Furthermore, there is evidence from the United Kingdom that CGA is associated with higher rates of chemotherapy completion and fewer treatment modifications in patients X70 years old (Kalsi et al, 2015). This is particularly important as the present study observed that only 33% of patients X75 year old, which comprised 44% of the study cohort, received adjuvant chemotherapy for stage III disease, and receipt of adjuvant chemotherapy significantly reduced the risk of 1-year overall and cancer-specific mortality.…”

Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research

“…On average, patients received 6.2 ± 2.6 geriatric management interventions (range 0–15). 24 However, this model of care relied upon geriatrician management, and the feasibility of developing and implementing such interventions independent of direct geriatrics involvement is not established.…”

Polypharmacy and potentially inappropriate medication use in geriatric oncology

“…35 In a study by Kalsi et al, GA interventions were shown to improve chemotherapy tolerance in older patients aged 70 or above undergoing chemotherapy. 61 In this population, 19% received intervention to reduce unnecessary medications such as adjustment of anti-hypertensive medications in over or undertreated patients. These interventions, however, vary across the various studies and were not clearly defined.…”