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Multidisciplinary Assessment Reduces Chemotherapy Toxicity For Older Cancer Patients

Older patients undergoing cancer treatment are less likely to experience grade 3 or more severe chemotherapy toxicity if given a multidisciplinary assessment during treatment planning
05 Oct 2021
Complications/Toxicities of Treatment;  Geriatric Oncology

Author: By Lynda Williams, Senior medwireNews Reporter 

 

medwireNews: Using a multidisciplinary assessment tool during cancer treatment planning for older adults can significantly reduce the likelihood of grade 3 and more severe adverse events (AEs) from chemotherapy, researchers report. 

Writing in JAMA Oncology, the study investigators describe the geriatric assessment-driven intervention (GAIN) as being “a clinically meaningful model” that “should be included as a part of standard care for all older adults with cancer”. 

GAIN was conducted by a multidisciplinary team comprising an oncologist, a nurse practitioner, a social worker, a physical or occupational therapist, a nutritionist and a pharmacist. In particular, they assessed the need for interventions related to functional status, comorbidity, psychological status, social activity, social support, nutrition, cognition, polypharmacy and spiritual wellbeing, as well as clinical symptoms. 

The randomised controlled trial recruited individuals aged at least 65 years who were attending a cancer centre between 2015 and 2019 to begin a new chemotherapy regimen for a solid malignancy, explain Daneng Li, from City of Hope Comprehensive Cancer Center in Duarte, California, USA, and co-authors. 

Specifically, the 605 patients were aged a median of 71 years, 59.0% were female, and the majority (71.4%) had stage IV disease; the most common tumour sites in the study population were gastrointestinal (33.4%), breast (22.5%), lung (16.0%), genitourinary (15.0%) and gynaecological (8.9%). 

Overall, 3971 possible interventions were identified among the 402 patients in the GAIN arm of the study, at an average of 10 interventions per patient, and the majority (76.8%) of interventions were implemented over the median 85 days of follow-up. 

Although the 203 patients in the standard-of-care arm were also recommended on average 10 interventions each, just 12.5% of the interventions were initiated over a median 80 days of follow-up by the treating oncologist without additional multidisciplinary advice. 

The primary outcome of grade 3 or more severe chemotherapy-related toxicity occurred in 50.5% of the GAIN patients versus 60.6% of controls, a significant 10.1 percentage point difference, report Daneng Li et al. 

Fewer haematological and nonhaematological toxicities of grade 3 and more severe were reported in the GAIN versus standard-of-care arms, with reductions of 8.0 and 8.2 percentage points, respectively, they say. 

The researchers note that a comparable proportion of GAIN and control patients had an advance directive on file at time of study entry (46.3 vs 48.8%). But by the time the study ended, 28.4% of the GAIN group without a baseline file had signed an advance directive compared with 13.3% of controls, a significant difference that resulted in a significantly higher proportion of GAIN patients having an advance directive overall (74.6 vs 62.1%). 

However, Daneng Li and co-authors say the two patient groups did not significantly differ with regard to the other secondary endpoints of emergency room visits, unplanned hospital stays, average length of hospital stay, hospital readmission, or requirement for chemotherapy dose modification or discontinuation.  

Furthermore, the patient survival rates were comparable in the GAIN and standard-of-care arms at both 6 months (84 vs 83%) and 12 months (66 vs 64%), “providing reassurance that implementing [geriatric assessment]-driven interventions mitigates chemotherapy-related toxic effects without compromising efficacy”, the investigators comment. 

Reference 

Li D, Sun C-L, Kim H, et al. Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer. A randomized clinical trial. JAMA Oncol; Advance online publication 30 September 2021. doi:10.1001/jamaoncol.2021.4158 

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2021 Springer Healthcare part of the Springer Nature group

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