A geriatric assessment summary with management recommendations supplied to community oncologists resulted in lower rates of treatment-related toxicity among older patients with cancer who were initiating a new treatment regimen, according to a study presented at the ASCO20 Virtual Scientific Program.
“A geriatric assessment evaluates geriatric domains such as function, physical performance, comorbidities in polypharmacy, cognition, nutrition, psychological status, and social support,” Supriya G. Mohile, MD, MS, of the University of Rochester Medical Center in New York, and lead author and presenter of the study, said. “Each of these domains independently predicts morbidity and mortality in older patients with cancer,” she added, “yet only 20% of community oncologists use geriatric assessment in clinical practice.”
A geriatric assessment is beneficial because older patients, particularly those with comorbidities, are frequently underrepresented in clinical trials. As a result, community oncologists may find treatment decisions to be challenging in this population due to a lack of data. The purpose of this study was to determine if a geriatric assessment and treatment recommendations can reduce toxicities related to treatment.
The study included 718 patients from 41 community oncology practices who were older than 70 years with incurable solid tumors or lymphoma and who were initiating a new treatment regimen. All patients had more than 1 impaired domain on geriatric assessment.
The community oncology practices were randomized to receiving the intervention, which included a geriatric assessment summary with treatment recommendations, or usual care. The primary endpoint was rate of grade 3 to grade 5 toxicities within 3 months. Secondary endpoints included overall survival (OS) at 6 months and treatment intensity.
At baseline, the median age of enrolled patients was 77 years and 43% were female. The intervention arm included a higher number of patients who were black, had gastrointestinal cancer, and who had received prior chemotherapy. The majority of patients (88%) received chemotherapy. The median number of impaired domains on geriatric assessment was 4 out of 8, with the most common impairments in the domains of physical performance, polypharmacy, comorbidities, functional status, and nutrition.
Overall, during the first 3 months of treatment, the rate of grade 3 to grade 5 toxicities was 60.9%, and 50% of patients required dose modifications, whereas 17.7% discontinued treatment.
The practices that received a geriatric assessment with treatment recommendations demonstrated a lower rate of grade 3 to grade 5 toxicities among their enrolled patients; it was 50% compared with 71% in patients from practices in the usual-care group (relative risk [RR], 0.74; 95% CI, 0.63-0.87; P =.0002). Both hematologic and nonhematologic toxicities occurred more frequently in the usual-care arm.
There was no significant difference in OS between groups. The 6-month OS was 71.3% in the intervention group compared with 74.3% in the usual-care group (P =.33).
Reduced treatment intensity at cycle 1 occurred more frequently in the intervention group at 48.7% compared with 35% in the usual-care arm (RR; 1.37; 95% CI, 1.06-1.76; P =.016). Dose modifications due to toxicities occurred less often in the intervention arm (42.1%) compared with the usual-care arm (57.5%), but was nonsignificant when adjusted for specific oncology practice (RR, 0.85; 95% CI, 0.67-1.08; P =.190).
Dr Mohile concluded that “a geriatric assessment intervention improved toxicity outcomes for older patients with advanced cancer receiving palliative treatment without significantly lowering survival at 6 months.” She said that “this may be due to reduced treatment intensity provided at cycle 1.”
Mohile SG, Mohamed MR, Culakova E, et al. A geriatric assessment (GA) intervention to reduce treatment toxicity in older patients with advanced cancer: A University of Rochester Cancer Center NCI community oncology research program cluster randomized clinical trial (CRCT). Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 12009.