Geriatric assessment–driven interventions—such as physical therapy, nutritional recommendations, and social support, among others—can reduce toxicity due to chemotherapy in adults with cancer aged 65 years and older, according to results from a randomized clinical trial presented as part of ASCO20 Scientific Virtual Program (Abstract 12010). Daneng Li, MD, the trial’s principal investigator, reported results from the study of 600 patients with solid tumors. Dr. Li is an Assistant Clinical Professor in the Department of Medical Oncology & Therapeutics Research at City of Hope in Duarte, California.
“Geriatric assessment focuses on capturing the whole person, such as how much physical activity the patient can perform, what serious medical conditions he or she might have, a patient's psychological status, and other factors,” said Dr. Li in a statement.
The median age of patients in the study was 71 years, and most of the patients had stage IV disease, including gastrointestinal cancer in approximately one-third of patients (33%); the remaining two-thirds had breast, lung, genitourinary, or other solid tumor cancers. Before receiving chemotherapy, all patients completed a geriatric assessment tool to assess functional status, comorbidity, and cognition to determine their functional age. Patients were then randomly assigned to a geriatric assessment–driven intervention arm or standard of care in a 2:1 ratio, with 398 assigned to the intervention arm and 202 patients assigned to standard of care.
The primary endpoint was the incidence of grade 3 to 5 toxicity associated with chemotherapy.
Those in the intervention arm received chemotherapy only after review of their geriatric assessment by a multidisciplinary team, including a geriatric oncologist, nurse practitioner, social worker, physical/occupational therapist, nutritionist, and pharmacist. The team evaluated results of the patients’ assessments and assigned interventions such as physical therapy, nutritional recommendations, or social support based on predefined triggers.
For patients in the standard of care arm, results of the geriatric assessment were sent to the treating oncologist to be used at his or her discretion.
The patients were followed until their chemotherapy ended or for 6 months of chemotherapy. Researchers then measured how many serious chemotherapy-related toxicities each group developed.
Results and Discussion
Dr. Li reported a 9.9% reduction in incidence of grade 3 to 5 toxicity (95% confidence interval = 1.6%–18.2%, P = .02) in the interventional arm compared to patients receiving standard care (50.5% vs 60.4%). Additionally, researchers reported more patients completed advanced directives, a secondary endpoint, in the interventional arm compared to those receiving standard of care (24.1% vs 10.4%, P < .001). No significant differences were reported in emergency department visits, hospitalizations, or the average number of days hospitalized between the two groups.
The authors concluded, “Integration of multidisciplinary [geriatric assessment]–driven interventions reduced grade 3 to 5 chemotherapy-related toxicity and improved [advanced directive] completion in older adults with cancer. [Geriatric assessment]–driven interventions should be included as a part of cancer care for all older adults.”
In discussing the outcomes of the study, Dr. Li explained, “What the assessment does is it really helps a patient’s medical team understand the true nature of the patient that you’re treating rather than just one area of the patient. You’re getting a much richer picture of who this person is, how treatment can potentially impact them, and approaches the medical team can take to reduce any negative impact.”
He added, “This is one of the first studies to show that if you intervene based on a patient’s geriatric assessment and provide them with the appropriate interventions, you can actually decrease someone's toxicity from chemotherapy in an older adult population.”
Legacy of the Geriatric Assessment Tool
Arti Hurria, MD
The geriatric assessment tool was developed by the late Arti Hurria, MD, Founding Director of City of Hope's Center for Cancer and Aging.
“One of Dr. Hurria's dreams was that one day all older adults with cancer can receive personalized, tailored care,” said Dr. Li. He added, “We want to make sure that her dream is realized, and that patients continue to benefit from her vision.”
Dr. Li and his team hope to expand geriatric assessment and interventions to other cancer centers. Their plan is to develop implementation of geriatric assessment and interventions that can be delivered via telemedicine.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.