In the Canadian 5C study reported in the Journal of Clinical Oncology, Puts et al found that a geriatric assessment and management intervention did not improve quality of life, unplanned health-care use, mortality, or toxicity compared with usual care in patients aged 70 years or older with cancer.
Study Details
The multicenter trial included 350 patients with solid tumors or hematologic malignancies referred for first-/second-line chemotherapy, immunotherapy, or targeted therapy who had an Eastern Cooperative Oncology Group performance status of 0 to 2. Patients were randomly assigned between March 2018 and March 2020 to receive a 6-month geriatric assessment and management intervention (n = 173) or usual care (n = 177).
The intervention consisted of a standardized geriatric assessment (covering functional status, mood, cognition, nutritional status, medications, comorbidity, mobility and falls, and social support); based on assessment, predefined evidence-based interventions were implemented. The primary outcome of interest was quality of life measured on the global health scale of the EORTC QLQ C30 in the intention-to-treat population.
Key Findings
Most patients in the geriatric assessment and management intervention group elected to complete the geriatric assessment on the first day of treatment or during treatment. The adjusted difference in global quality of life score at baseline was 4.3 points in favor of the control group. The difference was maintained over time, with a difference of 4.4 points (minimal clinically important difference = 10 points) favoring the control group observed at 6 months (P = .93); no significant difference was observed at 12 months (P = .89).
Grade ≥ 3 toxicity occurred in 54 patients (35.3%) in the intervention group vs 65 (40.1%) in the control group (odds ratio = 0.74, P = .21). Death within 12 months occurred in 38 patients (22.0%) in the intervention group vs 41 (23.2%) in the control group (hazard ratio = 0.99, P = .97).
Any impairment in functioning was present in 49.1% of the intervention group and 46.3% of the control group at baseline. No differences between groups in functional limitation were observed at 6 months (P = .53) or 12 months (P = .36).
No significant differences in the intervention group vs the control group were observed for emergency department visits (risk ratio [RR] = 0.89, P = .25) or unplanned hospitalization (RR = 0.99, P = .94) through 12 months. Cancer treatment plans were modified on the basis of geriatric assessment in three patients (1.7%) in the intervention group.
The proportion of patients who reported being satisfied or completely satisfied with their care at 6 months was 94.2% in the intervention group vs 97.6% in the control group (P = .21).
The investigators concluded, “Geriatric assessment and management did not improve quality of life. Most intervention group participants received geriatric assessment on or after treatment initiation per patient request. Considering recent completed trials, geriatric assessment may have benefit if completed before treatment selection. The COVID-19 pandemic may have affected our quality of life outcome and intervention delivery for some participants.”
Martine Puts, RN, PhD, FAAN, of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Canadian Cancer Society and others. For full disclosures of the study authors, visit ascopubs.org.
