In a single-center study reported in JAMA Oncology, Daneng Li, MD, and colleagues found that a geriatric assessment–driven intervention (GAIN) was associated with a reduced incidence of grade ≥ 3 adverse events and a higher frequency of completion of advance directives vs standard of care among patients aged ≥ 65 years beginning a new chemotherapy regimen for solid tumors.
Daneng Li, MD
In the trial, 605 evaluable patients starting a new chemotherapy regimen at City of Hope National Medical Center were randomly assigned 2:1 between 2015 and 2019 to receive GAIN (n = 402) or standard of care (n = 203). All patients underwent geriatric assessment. In the GAIN group, a geriatrics-trained multidisciplinary team including an oncologist, nurse practitioner, social worker, physical/occupation therapist, nutritionist, and pharmacist reviewed geriatric assessment results and implemented interventions based on prespecified thresholds within the geriatric assessment domains. In the standard-of-care group, treating oncologists received results of the geriatric assessment. The primary outcome measure was incidence of grade ≥ 3 chemotherapy-related toxicity, with patients being followed until chemotherapy completion or 6 months after treatment initiation—whichever came earlier.
Among all patients, median age was 71 years (range = 65–91 years); 59.0% were women; 71.4% had stage IV disease; and cancer types included gastrointestinal (33.4%), breast (22.5%), lung (16.0%), genitourinary (15.0%), gynecologic (8.9%), and other (4.1%).
The incidence of grade ≥ 3 chemotherapy-related toxicity was 50.5% (95% confidence interval [CI] = 45.6%–55.4%) in the GAIN group vs 60.6% (95% CI = 53.9%–67.3%) in the standard-of-care group (difference = –10.1%, 95% CI = −1.5 to −18.2%, P = .02). Significant reductions were observed in hematologic-only toxicity (8.0% reduction, 95% CI = −1.8% to −14.3%, P = .003) and in nonhematologic-only toxicity (8.2% reduction, 95% CI = −1.0% to −15.4%, P = .007).
Proportions of patients with completed advanced directives increased from 46.3% vs 48.8% (P = .56) at baseline to 74.6% vs 62.1% (P = .001), with absolute increases of 28.4% vs 13.3%.
No significant differences between groups were observed in emergency department visits (27.4% vs 30.5%), unplanned hospitalizations (22.1% vs 19.2%), average length of stay (median = 5 vs 5 days), unplanned readmissions (19.1% vs 20.5%), chemotherapy dose modifications (54.2% vs 46.8%), or chemotherapy discontinuations (53.7% vs 58.1%). With a maximum follow-up for overall survival of 12 months following start of chemotherapy, estimated rates at 6 and 12 months were 84% vs 83% and 66% vs 64% (P = .55).
The investigators concluded, “In this randomized clinical trial, integration of multidisciplinary GAIN significantly reduced grade 3 or higher chemotherapy-related toxic effects in older adults with cancer. Implementation of GAIN into oncology clinical practice should be considered among older adults receiving chemotherapy.”
Dr. Li, of City of Hope Comprehensive Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was funded by the UniHealth Foundation and National Institute on Aging. For full disclosures of the study authors, visit jamanetwork.com.