Cancer care

Routine geriatric assessment adds value to cancer care: Monash study

Integrated oncogeriatric care can improve quality of life, reduce unplanned hospital admissions, and facilitate continuation of planned treatment in older people with solid and haematological malignancies, Australian research shows.

A Monash University study tested the effectiveness of a comprehensive geriatric assessment (CGA) integrated into oncology care in an open-label RCT comprising 154 cancer patients >70 years who were planned for chemotherapy, targeted therapy or immunotherapy.

The intervention consisted of a standardised panel of geriatric assessment questionnaires, followed by geriatrician consultation at baseline, and follow-up visits at 12 weeks and 24 weeks, with additional reviews as medically required.

Other patients received usual care which could include referral to a geriatrician and supportive care screening.

The study, published in the Lancet Healthy Longevity, found deterioration in the social functioning domain of the health-related quality of life (HRQOL) measure was greater in the usual care group than the integrated oncogeriatric care group at week 18.

“The health care utilisation analysis showed that the integrated oncogeriatric care group had fewer emergency presentations (–1·3 presentations per person-year at risk; multivariable-adjusted incidence rate ratio 0·59 [95% CI 0·41–0·85];p=0·0049), fewer unplanned hospital admissions (–1·2 admissions per person-year; 0·60 [0·42–0·87]; p=0·0066), and fewer unplanned hospital days (–7·0 days per person-year; 0·77 [0·68–0·86]; p<0·0001) at 24 weeks after enrolment,” the study said.

There was no difference in overall survival between the two groups.

Exploratory analyses also showed that participants in the integrated oncogeriatric care group were less likely to have early discontinuation of planned anticancer treatment at 24 weeks after enrolment (33% vs 53%) compared to the usual care group.

“This finding was driven by lower discontinuation due to treatment toxicity (seven [10%] of 73 participants in the integrated oncogeriatric care group vs 27 [35%] of 77 participants in the usual care group; multivariable-adjusted OR 0·18 [95% CI 0·07–0·47]; p=0·0013).”

“Application of the principles of CGA and health-care integration in an augmented model of care led to better person-centred, treatment-related, and health-care-level outcomes,” the investigators said.

They added that while CGA occurred mostly after starting cancer treatment, the findings suggest a role for CGA-guided supportive interventions to maintain HRQOL and functioning.

A Comment article in the journal said the findings of reductions in ED visits and hospital admissions suggest the intervention might well be sustainable.

However one size does not fit all when implementing oncogeriatric care models, it said.

“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).”

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