Geriatric Assessments May Open the Door to High-Quality Conversations About Frailty and Aging-Related Concerns in Older Patients With Advanced Cancer

Older patients with advanced cancer who had higher degrees of frailty may be having more and higher-quality conversations about aging-related concerns if they underwent geriatric assessment and received further interventions to potentially mediate issues that older patients with cancer were experienced that were identified by the geriatric assessment, according to a recent study.

“The more frail that patients were, the more oncologists recommended evidence-based recommendations,” Nikesha Gilmore, a research assistant professor in the department of surgery at University of Rochester Medical Center in New York, told CURE®. “In addition, we also showed that in the intervention arm, when patients, their caregivers and oncologists were given information about patients’ impairments identified by the geriatric assessment, the more frail they were, the more they were talking about aging-related concerns and implementing a lot more services that were related to the issues that they’re facing.”

Gilmore and colleagues conducted additional analysis of a primary study ran by Dr. Supriya Mohile that showed a geriatric assessment intervention improved the number and quality of communications about aging-related concerns between older patients with advanced cancer and their oncologists. Gilmore’s study extended these findings by examining the effects of the geriatric assessmentintervention on communication in patients with various levels of frailty.

Gilmore explained that communication between patients with cancer and their oncologists about issues that extend beyond cancer and its treatment is important.

“How patients and oncologists communicate is really important, not just about issues related to the patient’s cancer and its cancer treatment, but a lot of things outside of cancer treatment, especially as it relates to older adults, because these factors matter a lot in terms of their quality of life and their wellbeing, also in terms of decision making related to their cancer care,” she said.

The study, which was published in Cancer, focused on 541 patients aged 70 years and older with incurable cancer and who were considered to have some level of frailty based on geriatric assessments: robust (27%), prefrail (42%) or frail (31%). In particular, the geriatric assessments included factors such as cognition, nutrition, level of physical activity and anxiety.

Patients were assigned either an intervention based on the geriatric assessment (293 patients) or usual care (248 patients). Only patients in the intervention group received a summary of their impairments identified by the geriatric assessment with a list of recommendations based on those results to address certain impairments. The quantity and quality of the conversations between patients and their caregivers from both groups and their oncologists were assessed throughout the study.

“The quality of the conversations was really a measure of what occurred after an aging related concern was raised. For example, if a patient says, ‘I am falling,’ … then the physician responds and acknowledges that the patient is falling, and the physician further responds to that aging-related concern of falling and recommended that the patient completes physical therapy, this will be considered as high-quality communication,” Gilmore said. “Because (the oncologist is) doing something more, they implemented an intervention, recommended that the patient get something more out of that initial concern, we defined it as being a high-quality conversation.”

Results from this study demonstrated that frail patients, compared with robust patients, assigned either to the intervention or usual care typically engaged in more conversations of higher quality, in more aging-related conversations and more discussions about evidence-based recommendations.

In addition, patients in the geriatric assessment intervention group had significant improvements in the number and quality of conversations regardless of frailty status compared with those in the usual care group.

These findings highlight the important detail that patients are in charge of their care.

“(Patients are in control of their care) by advocating and telling physicians things that might be important to (patients) that is not just related to the cancer and their treatments,” Gilmore said. “(This includes) issues like if they’re having problems with their nutritional status, so they are losing weight without trying, or if they’re having problems with their physical function or cognition, because these issues are important to patients’ overall wellbeing. They’re in charge of their care, so they can bring this up. They shouldn’t be ashamed to talk to the oncologist about it.”

Gilmore added that a patient’s voice can be so powerful throughout this process.

“Overall, as patients, (remember) that your voice is really important,” she said. “And that’s why communication is really important. It’s really what this study is highlighting, that how patients and their caregivers (can communicate) with the oncologist is really important and that a geriatric assessment helps guide patients, caregivers and oncologists with having these conversations especially in patients who are more frail”.

Caregivers can also play a role in this conversation, Gilmore mentioned.

“This is also important because by the caregiver telling the oncologist about issues that the patient is facing, because the caregiver might have a different perspective than the patient, can give the oncologist some more information that might be very important in making decisions about the patient’s care.”

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