Skip to main content

Advertisement

SpringerLink
Log in

Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Older adults receiving cancer therapy have heightened risk for treatment-related toxicity. Geriatric assessment (GA) can identify impairments, which may contribute to vulnerability and adverse outcomes. GA management interventions can address these impairments and have the potential to improve outcomes when implemented.

Methods

We conducted a randomized pilot study comparing GA with management interventions versus usual care in patients with stage III/IV solid tumor malignancies (N = 71). In all patients, a trained coordinator conducted and scored a baseline GA with pre-determined cutoffs for impairment. For patients randomized to the intervention arm, an algorithm was used to identify GA management recommendations based upon identified impairments. Recommendations were relayed to the primary oncologist for implementation. GA was repeated at 3 months. The primary outcome was grade 3–5 chemotherapy toxicity. Secondary outcomes included feasibility, hospitalizations, dose reductions, dose delays, and early treatment discontinuation.

Results

The mean participant age was 76 (70–89). The total number of GA management recommendations relayed was 409, of which 35.4% were implemented by the primary oncologist. Incidence of grade 3–5 chemotherapy toxicity did not differ between the two groups. Prevalence of hospitalization, dose reductions, dose delays, and early treatment discontinuation also did not differ between the two groups.

Conclusions

An algorithm can be used to guide GA management recommendations in older adults with cancer. However, reliance upon the primary oncologist for execution resulted in a low prevalence of implementation. Future work should aim to understand barriers to implementation and explore alternate models of implementing geriatric-focused care for older adults with cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Balducci L (Spring 2005) Epidemiology of cancer and aging. J Oncol Manag: Off J Am Coll Oncol Adm 14(2):47–50

    Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29

    Article  PubMed  Google Scholar 

  3. Koroukian SM, Murray P, Madigan E (2006) Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care. J Clin Oncol 24(15):2304–2310

    Article  PubMed  Google Scholar 

  4. Koroukian SM, Xu F, Bakaki PM, Diaz-Insua M, Towe TP, Owusu C (2010) Comorbidities, functional limitations, and geriatric syndromes in relation to treatment and survival patterns among elders with colorectal cancer. J Gerontol A Biol Sci Med Sci 65(3):322–329

    Article  PubMed  Google Scholar 

  5. Mohile SG, Fan L, Reeve E et al (2011) Association of cancer with geriatric syndromes in older Medicare beneficiaries. J Clin Oncol 29(11):1458–1464

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hurria A, Browner IS, Cohen HJ et al (2012) Senior adult oncology. J Natl Compr Cancer Netw : JNCCN 10(2):162–209

    Article  CAS  Google Scholar 

  7. Repetto L, Fratino L, Audisio RA et al (2002) Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 20(2):494–502

    Article  PubMed  Google Scholar 

  8. Hurria A, Gupta S, Zauderer M et al (2005) Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 104(9):1998–2005

    Article  PubMed  Google Scholar 

  9. Hurria A, Togawa K, Mohile SG et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Extermann M, Boler I, Reich RR, et al (2011) Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer

  11. Hurria A, Mohile S, Gajra A et al (2016) Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol 34(20):2366–2371

    Article  PubMed  PubMed Central  Google Scholar 

  12. Magnuson A AH, Cohen HJ, Mohile SG, Williams GR, Chapman A, Extermann M, Olin RL, Targia V, Mackenzie A, Holmes HM, Hurria A (2016) Geriatric assessment with management in cancer care: current evidence and potential mechanisms for future research. J Geriatr Oncol

  13. Caillet P, Canoui-Poitrine F, Vouriot J et al (2011) Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. J Clin Oncol 29(27):3636–3642

    Article  PubMed  Google Scholar 

  14. Kalsi T, Babic-Illman G, Ross PJ et al (2015) The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people. Br J Cancer 112(9):1435–1444

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bourdel-Marchasson I, Blanc-Bisson C, Doussau A et al (2014) Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial. PLoS One 9(9):e108687

    Article  PubMed  PubMed Central  Google Scholar 

  16. Goodwin JS, Satish S, Anderson ET, Nattinger AB, Freeman JL (Sep 2003) Effect of nurse case management on the treatment of older women with breast cancer. J Am Geriatr Soc 51(9):1252–1259

    Article  PubMed  Google Scholar 

  17. McCorkle R, Strumpf NE, Nuamah IF et al (Dec 2000) A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc 48(12):1707–1713

    Article  CAS  PubMed  Google Scholar 

  18. Rao AV, Hsieh F, Feussner JR, Cohen HJ (2005) Geriatric evaluation and management units in the care of the frail elderly cancer patient. J Gerontol A Biol Sci Med Sci 60(6):798–803

    Article  PubMed  Google Scholar 

  19. Nipp R, Sloane R, Rao AV, Schmader KE, Cohen HJ (2012) Role of pain medications, consultants, and other services in improved pain control of elderly adults with cancer in geriatric evaluation and management units. J Am Geriatr Soc 60(10):1912–1917

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 4:CD000340

    Google Scholar 

  21. Beswick AD, Rees K, Dieppe P et al (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371(9614):725–735

    Article  PubMed  PubMed Central  Google Scholar 

  22. Patterson SM, Cadogan CA, Kerse N et al (2014) Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev (10):CD008165

  23. Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds CF 3rd (2014) Managing depression in older age: psychological interventions. Maturitas 79(2):160–169

    Article  PubMed  PubMed Central  Google Scholar 

  24. Klainin-Yobas P, Oo WN, Suzanne Yew PY, Lau Y (2015) Effects of relaxation interventions on depression and anxiety among older adults: a systematic review. Aging Ment Health 19(12):1043–1055

    Article  PubMed  Google Scholar 

  25. Reijnders J, van Heugten C, van Boxtel M (2013) Cognitive interventions in healthy older adults and people with mild cognitive impairment: a systematic review. Ageing Res Rev 12(1):263–275

    Article  PubMed  Google Scholar 

  26. Bibas L, Levi M, Bendayan M, Mullie L, Forman DE, Afilalo J (2014) Therapeutic interventions for frail elderly patients: part I. Published randomized trials. Prog Cardiovasc Dis 57(2):134–143

    Article  PubMed  Google Scholar 

  27. Millen BE, Ohls JC, Ponza M, McCool AC (2002) The elderly nutrition program: an effective national framework for preventive nutrition interventions. J Am Diet Assoc 102(2):234–240

    Article  PubMed  Google Scholar 

  28. Frese T, Deutsch T, Keyser M, Sandholzer H (2012) In-home preventive comprehensive geriatric assessment (CGA) reduces mortality—a randomized controlled trial. Arch Gerontol Geriatr 55(3):639–644

    Article  PubMed  Google Scholar 

  29. Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ (1994) An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc 42(6):630–638

    Article  CAS  PubMed  Google Scholar 

  30. Bula CJ, Berod AC, Stuck AE et al (1999) Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 47(4):389–395

    Article  CAS  PubMed  Google Scholar 

  31. Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D (2011) Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 7:CD006211

    Google Scholar 

  32. Caplan GA, Williams AJ, Daly B, Abraham K (2004) A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department—the DEED II study. J Am Geriatr Soc 52(9):1417–1423

    Article  PubMed  Google Scholar 

  33. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342(8878):1032–1036

    Article  CAS  PubMed  Google Scholar 

  34. Kuo HK, Scandrett KG, Dave J, Mitchell SL (2004) The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysis. Arch Gerontol Geriatr 39(3):245–254

    Article  PubMed  Google Scholar 

  35. Mohile SG, Velarde C, Hurria A et al (2015) Geriatric assessment-guided care processes for older adults: a Delphi consensus of geriatric oncology experts. J Natl Compr Cancer Netw : JNCCN 13(9):1120–1130

    Article  Google Scholar 

  36. O'Donovan A, Mohile SG, Leech M (2015) Expert consensus panel guidelines on geriatric assessment in oncology. Eur J Cancer Care 24(4):574–589

    Article  Google Scholar 

  37. Hurria A, Levit LA, Dale W, et al (2015) Improving the evidence base for treating older adults with cancer: American Society of Clinical Oncology Statement. J Clin Oncol

  38. Epstein AM, Hall JA, Fretwell M et al (1990) Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization. JAMA 263(4):538–544

    Article  CAS  PubMed  Google Scholar 

  39. Baitar A, Kenis C, Moor R et al (Sep 2015) Implementation of geriatric assessment-based recommendations in older patients with cancer: a multicentre prospective study. J Geriatr Oncol 6(5):401–410

    Article  PubMed  Google Scholar 

  40. Fisher E, Hasselberg M, Conwell Y, et al (2017) Telementoring primary care clinicians to improve geriatric mental health care. Popul Health Manag

  41. Christmas C, Park E, Schmaltz H, Gozu A, Durso SC (2008) A model intensive course in geriatric teaching for non-geriatrician educators. J Gen Intern Med 23(7):1048–1052

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The work was funded by Wilmot Research Fellowship Award and R03 AG042342 and with support from the National Cancer Institute R25 CA102618.

Author information

Authors and Affiliations

  1. University of Rochester, Rochester, NY, USA

    Allison Magnuson, Chintan Pandya, Molly Goodman, Marcus Noel, Mohammed Tejani, David Doughtery, Michelle Janelsins, Feng Vankee Lin, Charles Heckler & Supriya Mohile

  2. New York Medical College, Valhalla, NY, USA

    Tatyana Lemelman

  3. University of Chicago, Chicago, IL, USA

    William Dale

  4. City of Hope, Duarte, CA, USA

    Arti Hurria

  5. Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA

    Supriya Mohile

Authors
  1. Allison Magnuson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatyana Lemelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chintan Pandya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Molly Goodman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcus Noel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohammed Tejani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Doughtery
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Arti Hurria
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michelle Janelsins
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Feng Vankee Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Charles Heckler
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Supriya Mohile
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Supriya Mohile.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Magnuson, A., Lemelman, T., Pandya, C. et al. Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study. Support Care Cancer 26, 605–613 (2018). https://doi.org/10.1007/s00520-017-3874-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-017-3874-6

Keywords

Search

Navigation