In a study reported in the Journal of Oncology Practice, Nathwani et al found that the use of a tablet-based modified geriatric assessment during physician visits by older patients with multiple myeloma was feasible and provided physicians with information that influenced treatment decisions.
Study Details
The study involved 165 patients aged ≥ 65 years making visits for treatment decisions at four sites. Patients had a mean age of 72 years, 56% were male, and 72% were white.
They completed a tablet-based modified geriatric assessment that included Katz Activities of Daily Living (ADL) and Lawton Instrumental ADL items, Charlson Comorbidity Index, and variables from the Cancer and Aging Research Group’s Chemotherapy Toxicity Calculator. Providers reviewed the assessment results at the time of the visit.
Survey Outcomes and Effect on Decisions
KEY POINTS
- The modified geriatric assessment was completed in an average of 7.7 minutes.
- 69% of providers indicated that assessment results influenced treatment decisions.
Patient survey completion required an average of 7.7 minutes (range = 2–17 minutes). Provider review of results required an average of 3.2 minutes (range = 1–10 minutes). Based on International Myeloma Working Group frailty score, 39% of patients were fit, 33% were intermediate fit, and 28% were frail.
Overall, 69% of providers (n = 17) agreed or strongly agreed that the modified geriatric assessment influenced treatment recommendations for their patient. Providers were more likely to select more aggressive treatment (ie, increased dose or dose intensity) for fit patients and less aggressive treatment (reduced number of agents, regimens with less toxicity, or different route of administration) for frail patients (P < .0001). A significant association was observed between patient fitness or frailty and whether the patient was considered eligible for autologous stem cell transplantation (P = .004). A trend towards increased incidence of dose modification among frail patients was observed during 3-month follow-up (P = .09).
The investigators concluded, “Limited patient time required for survey completion and provider time for results review show [modified geriatric assessment] can be easily incorporated into clinical workflow. Real-time [modified geriatric assessment] results indicating fit/frailty status influenced treatment decisions.”
Debra Wujcik, PhD, RN, of Carevive Systems, Miami, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit jop.ascopubs.org.
