Formal discussant of the abstract, Monika K. Krzyzanowska, MD, a medical oncologist at Princess Margaret Cancer Centre and Professor of Medicine at the University of Toronto, said this study extends the evidence base on geriatric assessment in oncology and shows that geriatric assessment should be considered for all older patients starting systemic treatment.
Dr. Krzyzanowska also highlighted a number of strengths to the trial, including the cluster randomized design, the large number of participating practices, and the standardized, clearly defined intervention. Given the size of the study, she said, the intervention is also “quite generalizable.”
Unanswered Questions
According to Dr. Krzyzanowska, however, there are still a number of unanswered questions, including the representativeness of participating clusters. Information on implementation experience and outcomes would also be welcome to try to understand what the active ingredient is, she observed.
Monika K. Krzyzanowska, MD
“The recommendations that were provided to the oncologist included potential dose reductions needed, as well as referrals to social work or physiotherapy,” said Dr. Krzyzanowska. “It would be interesting to see which one of the recommendations were actually carried out, or whether it’s just the advice on dose reductions that is the main active ingredient.”
Dr. Krzyzanowska also noted that she would like to know long-term outcomes to see whether dose reductions upfront translated into negative long-term outcomes. Finally, but certainly not least, she said, an economic evaluation would be welcome.
“This trial provides a real-world example of how to deliver geriatric assessments at a scale that may be transferable to other settings,” Dr. Krzyzanowska concluded. “Information on implementation outcomes will help us to understand the mechanism and how to do this effectively at scale.”
DISCLOSURE: Dr. Krzyzanowska has received honoraria from Eisai and Novartis; has served as a consultant or advisor to Bayer and Eisai; and has received institutional research funding from Eisai, Exelixis, and Ipsen.
