Study Finds Geriatric Co-Management to be Effective for Older Patients with Cancer

A retrospective cohort study published in JAMA Network Open found that geriatric co-management was associated with significantly lower 90-day postoperative mortality among older patients with cancer.

Overall, the findings suggest that this patient population may benefit from geriatric co-management, which could potentially improve their ability to survive adverse postoperative events.

“This finding should be assessed in the future by conducting randomized clinical trials,” the authors noted.

The study cohort included retrospectively identified patients aged 75 years and older who underwent cancer-related surgical treatment at Memorial Sloan Kettering Cancer Center between February 2015 and February 2018. Moreover, the cohort included patients with various tumor types who underwent elective surgical treatment within 60 days of their first visit with the surgeon and required a hospital stay of at least 1 day.

Overall, 1892 patients were included in the final study population, 1020 (53.9%) of which received geriatric co-management of care. Compared with those who received care managed by the surgery service only, those who received geriatric co-management of care were older (mean [SD] age, 81 [4] years vs 80 [4] years; P < .001), had longer operative time (mean [SD], 203 [146] minutes vs 138 [112] minutes; P < .001), and longer length of stay (median [interquartile range], 5 [3-8] days vs 4 [2-7] days; P < .001).

“At our institution, the geriatrics service discusses the risks and benefits of sedative medications (eg, benzodiazepines) with patients and their caregivers. Unless patients are using these medications chronically, we recommend these medications not be used in the perioperative period,” the authors explained. “Such interventions may be associated with a decrease in postoperative delirium, which is shown to be associated with postoperative mortality.”

Notably, there were no differences in the proportions of men (488 [47.8%] men vs 450 [51.6%] men; P = .11). In addition, surgical adverse events (AEs) did not vary significantly between groups (OR, 0.93; 95% CI, 0.73-1.18; P = .54). However, following surgical treatment, the adjusted probability of death within 90 days was 4.3% for the geriatric comanagement group vs 8.9% for the surgical service group (difference, 4.6%; 95% CI, 2.3%-6.9%; P < .001).

Further, compared with those who received postoperative care management from the surgery service exclusively, a higher proportion of patients in the geriatric comanagement group received inpatient supportive care services, including physical therapy (555 patients [63.6%] vs 820 patients [80.4%]; P < .001), occupational therapy (220 patients [25.2%] vs 385 patients [37.7%]; P < .001), speech and swallow rehabilitation (42 patients [4.8%] vs 86 patients [8.4%]; P = .002), and nutrition services (637 patients [73.1%] vs 803 patients [78.7%]; P = .004).

“The difference in use of supportive care services continued after hospital discharge,” the authors wrote. “Such services may play a role in attenuating the adverse outcomes associated with surgical stress on these patients. Future studies should assess how often such services are used and their effects on outcomes in the perioperative period.”

Importantly, the researchers suggested that the exact details of the perioperative care process, such as treatment optimization of comorbid conditions, additional consultations, and tests requested by the geriatrics service compared to the surgery team, as well as specific interventions in the postoperative period, are beyond the scope of this study and will be assessed in future studies comprising better-defined groups of patients.

Reference:

Shahrokni A, Tin AL, Sarraf S, et al. Association of Geriatric Comanagement and 90-Day Postoperative Mortality Among Patients Aged 75 Years and Older With Cancer. JAMA Network Open. doi: 10.1001/jamanetworkopen.2020.9265