Integrated Geriatric Assessment Improved HRQOL in Older Adults with Cancer

Integration of a comprehensive geriatric assessment with geriatrician-led management care improved health-related quality of life (HRQOL), unplanned hospital admissions, and treatment discontinuation among older adults undergoing systemic therapy for their cancer.

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.^1-2

“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.

“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,” he added. “These findings suggest that those aged 70 or older with cancer should receive a geriatric clinical assessment to optimize their care and health outcomes.”

In the INTEGERATE study, those who received the intervention – which is a detailed systematic evaluation identifying medical, psychosocial, and functional limitations – had improved Elderly Functional Index (ELFI) scores, compared with those who received usual care across all follow-up points. However, the maximal difference in scores was seen at week 18 (estimated marginal mean ELFI score, 72.0 vs 58.7; 95% CI, 5.5-21.2; P = 0.001), but this was reduced by week 24 (estimated marginal mean ELFI score, 73.1 vs 64.6; 95% CI, 0.5-16.5; P = 0.037).

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%; P < .001), as well as a reduction in early treatment discontinuations (32.9% vs 53.2%; P = 0.01) among those who received intervention versus those who did not. Soo attributed the decline to be driven by reduced treatment-related toxicity, and pointed out that this could potentially be cost saving. Lastly, the number of overnight stays geriatric patients with cancer had decreased by 7 days per person per year (24%). 

The trial included 154 patients aged >70 years with cancer planned for chemotherapy, targeted therapy, or immunotherapy. Patients were randomized 1:1 to receive either geriatrician-led comprehensive geriatric assessment and management integrated with usual care (n = 76) or usual care alone (n = 78).

HRQOL – the primary end point – consisted of physical, role and social functioning; mobility, burden of illness and future worries, and was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-ELD14 at 0, 12, 18, and 24 weeks. Secondary end points included 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. 

“Currently, a person with cancer is typically referred to a geriatrician only in the later stages of their illness when they experience significant problems with completing everyday tasks,” the ASCO-issued release stated. “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.”

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 CancerNetwork, 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.”

References:

1. Soo WK. Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy. Presented at: 2020 ASCO Virtual Scientific Program; May 12, 2020. Abstract 12011.

2. ASCO press release. Integrating Geriatric Assessment and Management Into Cancer Care Improves Quality of Life, Reduces Hospital Admissions for Older Patients. Available from: https://www.asco.org/about-asco/press-center/news-releases/integrating-geriatric-assessment-and-management-cancer-care. Published May 13, 2020. Accessed May 13, 2020.