Geriatrician Assessment and Integrated Care May Help Older Patients as Well as the Health-Care System
A full geriatric assessment and geriatrician-led multidisciplinary care improved the quality of life of patients aged 70 and older undergoing chemotherapy, targeted therapy, or immunotherapy, according to results of a prospective, randomized, controlled, open-label trial, reported in a press briefing prior to the ASCO20 Virtual Scientific Program.1 Of note, patients in the intervention arm had fewer visits to the emergency room, fewer hospitalizations, and were able to stay on therapy longer than those randomly assigned to usual care.
“The randomized INTEGERATE trial is the first randomized clinical trial to demonstrate that an integrated approach involving geriatricians and oncologists in a team approach helped improve quality of life, reduced hospital admissions, and reduced early discontinuation of treatment due to adverse events,” said lead author Wee-Kheng Soo, MBBS, FRACP, a geriatrician and medical oncologist at Eastern Health, Melbourne, Australia.
“We have an aging global population, and oncologists are faced with the challenges of managing the health-care needs of older patients with cancer who are a vulnerable group. We need to optimize their health when receiving treatments that can have worrisome side effects,” he added.
About 60% of patients with cancer are older than age 65 when diagnosed, and about 70% of survivors are older than age 65. Yet older patients are often not included in randomized controlled trials, and many cancer clinics do not incorporate geriatricians’ input into their treatment plan.
“Comprehensive geriatric assessment is an evidence-based framework to assess an older person’s health profile and enables a coordinated, person-centered approach to care. The geriatric assessment can detect underrecognized health issues, increase supportive care, and influence cancer treatment. We can recognize health issues, physical limitations, polypharmacy, social isolation, and intervene,” Dr. Soo explained.
INTEGERATE enrolled 154 patients older than age 70 who were slated to undergo anticancer treatment with chemotherapy, targeted therapy, or immunotherapy. Patients were randomly assigned 1:1 to integrated oncogeriatric care or usual care.
“Integrated oncogeriatric care is a partnership between oncologists and geriatricians and involves comprehensive geriatric assessment and coordinated health-care delivery.”— Wee-Kheng Soo, MBBS, FRACP
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“Integrated oncogeriatric care is a partnership between oncologists and geriatricians and involves comprehensive geriatric assessment and coordinated health-care delivery,” Dr. Soo said. “It entailed geriatrician-led assessment and management, including health-care management and referrals.”
The primary outcome was quality of life, as measured by the Elderly Functional Index score. Quality of life was also assessed with the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire. Patients were evaluated at weeks 0, 12, 18, and 24.
Elderly Functional Index scores were significantly improved in patients in the geriatric-assessment group at 12, 18, and 24 weeks. At 12 weeks, there was an 11.1-point difference (on a 100-point scale) favoring geriatric assessment (P = .004); at 18 weeks, a 13.4-point difference (P = .001); and at 24 weeks, an 8.5-point difference (P = .037).
“We saw significant improvement in other quality-of-life areas, such as functioning [physical, role, social], mobility, burden of illness, and worrying about the future,” Dr. Soo noted. “The benefits in social functioning, burden of illness, and future worries domains persisted to the end of the study at week 24.”
- The INTEGRATED study offers the first randomized trial evidence to support geriatric assessment and oncogeriatric management of older patients undergoing anticancer treatments.
- Patients who underwent geriatric assessment and management based on findings from that assessment had fewer visits to the emergency room, fewer days in the hospital, improved quality of life, and were better able to complete treatment, presumably due to management of side effects and other health-related issues identified in the geriatric assessment.
- This study supports incorporating geriatric assessment into cancer care for patients older than age 70.
Regarding secondary outcomes, hospital utilization was reduced by 39% in the geriatric assessment–led group compared with usual care, with 1.3 fewer visits to the emergency room per person-year. There was a 43% reduction in unplanned hospital admissions in the geriatric assessment–led group, with 1.2 fewer unplanned hospital admissions per person-year. The geriatric assessment–led group also had a 24% reduction in overnight stays in a hospital bed, with a reduction of 7 days per person-year compared with usual care. “This led to significant cost savings,” added Dr. Soo. The geriatric assessment–led group also had a reduction in early treatment discontinuation due to adverse events (32.9% vs 53.2% for usual care).
“This study shows that older people planned for anticancer therapy should receive comprehensive geriatric assessment, which is beneficial on the patient level [quality of life, ability to continue treatment, and manage side effects] and on the system level [less health-care utilization].
“The INTEGERATE study provides randomized evidence to support wider-scale implementation of an integrated geriatric model of care.”— Wee-Kheng Soo, MBBS, FRACP
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"The INTEGERATE study provides randomized evidence to support wider-scale implementation of an integrated geriatric model of care,” concluded Dr. Soo.
DISCLOSURE: The study was funded by the National Health and Medical Research Council, Australia. Dr. Soo reported no conflicts of interest.
1. Soo WK, King M, Pope A, et al: Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy. 2020 ASCO Annual Meeting. Abstract 12011. Presented at press briefing on May 12.
"We have known for a long time, based on good evidence, that geriatric assessment is good at accurately identifying patients at high risk for chemotherapy-induced toxicity, surgical complications, and increased hospitalizations. This study adds an intervention component based on the geriatric...