Geriatric assessment and management reduces toxic effects of cancer treatment in elderly: Lancet
reduced the incidence of grade > 3 toxicity
USA: A recent study reported in the journal The Lancet found that a geriatric assessment for older patients with advanced cancer may reduce the serious toxic effects fro cancer treatment. The findings suggest that the clinical care of older patients with advanced cancer and aging-related conditions must include geriatric assessment with management.
Older adults with advanced cancer are known to be at a higher risk for toxic effects of cancer treatment. Geriatric assessment evaluates aging-related domains and guides management. Prof Supriya G Mohile, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA, and colleagues examined whether a geriatric assessment intervention can reduce serious toxic effects in older patients with advanced cancer who are receiving high-risk treatment (eg, chemotherapy) in a cluster-randomized trial.
The study enrolled patients aged 70 years and older with incurable solid tumors or lymphoma and at least one impaired geriatric assessment domain who were starting a new treatment regimen. 40 community oncology practice clusters across the USA were randomly assigned to the intervention (oncologists received a tailored geriatric assessment summary and management recommendations) or usual care (no geriatric assessment summary or management recommendations were provided to oncologists).
The primary outcome was the proportion of patients who had any grade 3–5 toxic effect (based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4) over 3 months. Toxic effects were prospectively captured by practice staff.
A total of 718 patients were enrolled between July 29, 2014, and March 13, 2019. The mean age of the patients was 77·2 years and 311 (43%) of 718 participants were female. The mean number of geriatric assessment domain impairments was 4·5 and was not significantly different between the study groups.
Following were the study's key findings:
- More patients in the intervention group compared with the usual care group were Black versus other races (40 [11%] of 349 patients vs 12 [3%] of 369 patients) and had previous chemotherapy (104 [30%] of 349 patients vs 81 [22%] of 369 patients).
- A lower proportion of patients in the intervention group had grade 3–5 toxic effects (177 [51%] of 349 patients) compared with the usual care group (263 [71%] of 369 patients; relative risk [RR] 0·74).
- Patients in the intervention group had fewer falls over 3 months (35 [12%] of 298 patients vs 68 [21%] of 329 patients; adjusted RR 0·58) and had more medications discontinued (mean adjusted difference 0·14).
"A geriatric assessment intervention for older patients with advanced cancer reduced serious toxic effects from cancer treatment," the authors wrote. "Geriatric assessment with management should be integrated into the clinical care of older patients with advanced cancer and aging-related conditions."
The study titled, "Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study," is published in the journal The Lancet.