In a secondary analysis of the Geriatric Assessment for Patients 70 Years and Older (GAP70+) trial reported in the Journal of Clinical Oncology, Eva Culakova, PhD, MS, and colleagues found that providing geriatric assessment–based recommendations to community oncologists was associated with reduced reporting of symptomatic toxicity, as measured by Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE), among patients initiating treatment for advanced cancer.
As noted by the investigators, the primary findings of GAP70+ showed that the geriatric assessment–guided management recommendations were associated with a significant reduction in serious treatment toxicity as measured by clinician-rated CTCAE.
In the U.S. study, patients with incurable solid tumors or lymphoma and one or more geriatric assessment domain impairment(s) other than polypharmacy who were initiating a new systemic treatment regimen with a > 50% prevalence of grade 3 to 5 toxicity were enrolled from 2014 to 2019. A total of 718 patients were cluster randomly assigned by community oncology practice to receive the geriatric assessment intervention (n = 349) or usual care (n = 369). Of these, 340 vs 366 had PRO-CTCAE data at baseline, and 296 vs 327 had follow-up data.
Patients were to report the severity of 24 symptoms (11 classified as core symptoms) at enrollment, 4 to 6 weeks, 3 months, and 6 months. Symptoms were scored as grade ≥ 2 (at least moderate) and grade ≥ 3 (severe/very severe). Symptomatic toxicity was determined by an increase in severity during treatment.
In the presence of a high baseline symptom burden, a geriatric assessment intervention for older patients with advanced cancer reduces patient-reported symptomatic toxicity.— Eva Culakova, PhD, MS, and colleagues
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Key Findings
Among the 706 patients completing PRO-CTCAEs at baseline, 86.1% reported at least one grade ≥ 2 symptom and 49.7% reported at least one grade ≥ 3 symptom at the start of treatment.
Among the 623 patients with follow-up PRO-CTCAE data, compared with patients in the usual-care group (n = 327), significantly fewer patients in the geriatric assessment intervention group (n = 296) reported grade ≥ 2 symptomatic toxicity overall (88.9% vs 94.8%, P = .035) and with regard to core symptoms (fatigue, pain, insomnia, decreased appetite, shortness of breath, diarrhea, constipation, memory problems, numbness/tingling in hands/feet, nausea, concentration problems; 83.4% vs 91.7%, P = .001) over 6 months. Fewer patients in the intervention group reported symptoms for all core symptoms except decreased appetite.
Numerically fewer patients in the geriatric assessment intervention group vs the usual-care group reported grade ≥ 3 symptomatic toxicity overall (68.2% vs 74.3%) and with regard to core symptoms (53.7% vs 59.9%) over 6 months, although the differences did not reach statistical significance.
The investigators concluded, “In the presence of a high baseline symptom burden, a geriatric assessment intervention for older patients with advanced cancer reduces patient-reported symptomatic toxicity.”
Marie Anne Flannery, PhD, RN, of the University of Rochester Medical Center School of Nursing, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by grants from the National Cancer Institute and National Institute on Aging. For full disclosures of the study authors, visit ascopubs.org.
