Older Adults With Cancer Experience Improved Outcomes with Integrated Geriatric Assessment

Researchers showed that the integration of a comprehensive geriatric assessment with geriatrician-led management care improved quality of life for older adults with cancer undergoing anti-cancer therapy.

The prospective, randomized, parallel-group, open-label INTEGERATE study, presented during a 2020 ASCO Virtual Scientific Program press briefing, is the first randomized study involving both geriatricians and oncologists for the care of older adults with cancer.

“Comprehensive geriatric assessment provides a powerful framework to assess an older person’s health and enables a coordinated, person-centered approach to care,” lead author Wee-Kheng Soo, MBBS, FRACP, a geriatrician and medical oncologist at Eastern Health in Melbourne, Australia, said during a pre-recorded presentation. “Comprehensive geriatric assessment is simply a comprehensive health assessment that focuses on vulnerabilities commonly seen in older people, including functional activities, medical issues, pharmacology, nutrition, memory problems, depression, and social isolation. By recognizing these problems early on, we apply interventions.”

According to an ASCO-issued press release, elderly patients with cancer are only referred to a geriatrician in the later stages of their illness when they experience significant problems with completing everyday tasks. “However, an integrated approach involving comprehensive geriatric assessment and early geriatrician involvement (also known as ‘integrated oncogeriatric care’) can help create a coordinated plan to optimize the older person with cancer.”

In their trial, the researchers included 154 patients aged 70 years or older with cancer who were planned to receive chemotherapy, targeted therapy or immunotherapy. Patients received either geriatrician-led comprehensive geriatric assessment and management (a detailed systematic evaluation identifying medical, psychosocial and functional limitations) integrated with usual care (76 patients) or usual care alone (78 patients).

The primary outcome being measured was health-related quality of life, which consisted of physical, role and social functioning; mobility, burden of illness and future worries. The researchers also evaluated patients’ function, mood, nutrition, health utility, treatment delivery, healthcare utilization and survival.

Assessment was conducted through self-reported questionnaires and a comprehensive assessment by a geriatrician.

Thirteen patients died by week 12 and 130 (92.2% of the remaining patients) completed at least two primary outcome assessments.

The researchers found that the integrated intervention led to improved Elderly Functional Index (ELFI) scores, compared with those who received usual care across all follow-up points.

The intervention group also experienced improvements in functioning, mobility, burden of illness and future worries, which persisted to the end of the study.

Moreover, the researchers saw an average of 1.3 fewer emergency room visits (39%) and 1.2 fewer unplanned hospital admissions per person per year (43%), as well as a reduction in early treatment discontinuations (32.9% versus 53.2%) among those who received intervention versus those who did not. Soo attributed the decline to reduced treatment-related toxicity and pointed out this could potentially be cost saving.

Lastly, the number of overnight stays geriatric patients with cancer had decreased by seven days per person per year (24%).

“We found that oncogeriatric care in older people with cancer about to receive anti-cancer therapy led to significant improvements in health outcomes — at the patient level, quality of life, as well as the system level’s outcomes, such as hospital utilization and treatment delivery,” lead author Wee-Kheng Soo, MBBS, FRACP, a geriatrician and medical oncologist at Eastern Health in Melbourne, Australia, said during a pre-recorded presentation. “These findings suggest that those aged 70 or older with cancer should receive a geriatric clinical assessment to optimize their care and health outcomes.”

The researchers intend to implement the integrated comprehensive geriatric assessment in a large, multicenter implementation study comparing different care models in geriatric oncology and different cancer settings.

“The number of people worldwide over the age of 65 is expected to continue to grow, making the need for more rigorous research to help optimize the quality of care we provide to older patients an urgent priority. This study shows that geriatric assessments lead to clear improvements in quality of life and better care planning for older patients with cancer,” Howard A. Burris III, MD, FACP, FASCO, ASCO president, said in the release.

In an interview with CURE, Dr. Cardinale B. Smith, chief quality officer of cancer services at the Mount Sinai Health System, commented on the study results. “The integration of comprehensive geriatric assessments should be incorporated more widely into the care of older adults with cancer.”