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Geriatric Assessment May Help Improve Communication With Older Cancer Patients

A routine geriatric assessment with tailored recommendations may improve communication about ageing-related concerns between patients, caregivers and oncologists
13 Nov 2019
Cancer in Special Situations;  Geriatric Oncology
By Lynda Williams, Senior medwireNews Reporter

medwireNews: Integrating a geriatric assessment (GA) into routine cancer care can help improve communication with older patients and their carers about the impact of treatment on ageing-related conditions, suggest study findings published in JAMA Oncology. 

“COACH demonstrated that a practical and convenient GA summary with recommendations for aging-sensitive interventions improves patient-centered outcomes and thus should be considered as the standard of care for older patients with cancer”, say Supriya Mohile, from the University of Rochester in New York, USA, and co-authors. 

The COACH cluster-randomised trial included 541 patients aged 70 years or older with advanced solid malignancy or lymphoma, and one or more GA domain impairments in functional status, physical performance, comorbidity, polypharmacy, cognition, nutrition, psychological health or social support.  

The patients attended 31 community oncology clinics associated with a US National Cancer Institute research programme based in Rochester between 2014 and 2017. The average 28-point modified Health Care Climate Questionnaire score for communication satisfaction about ageing-related concerns was 22.8 after their initial clinic visits. 

When compared with patients who were given usual care – consisting of recommendation alerts only for depression or cognitive impairment criteria – those who received a detailed GA summary and care recommendations were more satisfied with their clinic communication, with a 1.09 difference in mean score favouring use of the GA summary. A similar mean difference of 1.10 was found at the 6-month check point. 

Patients who received a tailored GA summary also had significantly more ageing-related conversations at clinic visits than controls (mean 8.02 vs 4.43) and high-quality conversations (mean 4.60 vs 2.59). 

And 4–6 weeks after the initial clinic visit, the 414 nominated caregivers reported greater satisfaction with communication about ageing-related conditions with the GA assessment than with usual care (mean difference 1.05) and with communication with the oncologist (mean difference 1.34), although these benefits did not persist at 6 months. 

However, neither the Functional Assessment of Cancer Therapy scale for patients, nor the 12-item Short Form Health Survey for caregivers revealed a significant quality of life (QoL) benefit with the GA assessment intervention compared with usual care. 

The authors of an invited commentary suggest that there may not have been adequate uptake or implementation of the recommendations in the patients’ GA summaries to achieve QoL improvement. 

“This possibility further underlines the importance of a multidisciplinary approach to provision of care in the older population, not only at initial assessment but throughout the entire care pathway”, say Laura Biganzoli, from Hospital of Prato in Italy, and co-authors. 

They recommend further research into how best to translate improvements in communication to QoL and whether such interventions can, in turn, translate into improvements in survival or adverse events. 

 

References  

Last update: 13 Nov 2019

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

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