A geriatric assessment-driven intervention (GAIN) can reduce the risk of severe adverse events (AEs) related to chemotherapy among older patients with cancer, according to research published in JAMA Oncology.

Researchers conducted a randomized study (ClinicalTrials.gov Identifier: NCT02517034) to evaluate whether GAIN is superior to standard of care (SOC) for reducing the risk of grade 3 or higher chemotherapy-related AEs, as well as the difference between these strategies on clinical outcomes in general.

Older adults with cancer were randomly assigned 2:1 to the GAIN arm (410 patients) or the SOC arm (203 patients). Baseline characteristics were well balanced between the intervention arms.


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Overall, the median age was 71 years (range, 65-91 years), 59% of patients were women, 78.7% were White, and 71.4% had stage IV disease. Cancer types included gastrointestinal (33.4%), breast (22.5%), lung (16%), genitourinary (15%), gynecologic (8.9%), and “other” cancers (4.1%).

About GAIN and SOC

Before starting chemotherapy, all patients in this study completed a baseline geriatric assessment and the Fulmer SPICES assessment. Their Cancer and Aging Research Group chemotherapy toxicity risk score was calculated as well.

For patients assigned to the GAIN arm, baseline assessments were reviewed by a geriatrics-trained multidisciplinary team (MDT), which included an oncologist, nurse practitioner (NP), pharmacist, physical therapist, occupational therapist, social worker, and nutritionist.

The MDT recommended appropriate interventions and referrals. The study NP reviewed the assessments and the MDT’s recommended plan and made appropriate referrals, informing the patient and treating oncologist. Chemotherapy was given at the discretion of the treating oncologist. The study NP followed up with the patient for additional support as needed.

For patients assigned to the SOC arm, baseline assessments were sent to the treating oncologist, who made decisions regarding chemotherapy and specialty referrals. There was no input from the MDT.

Results

The rate of grade 3 or higher treatment-related AEs was significantly lower in the GAIN arm than in the SOC arm — 50.5% and 60.6%, respectively (P =.02).

In addition, patients in the GAIN arm had a significantly higher rate of advance directive completion compared with the SOC arm — 28.4% and 13.3%, respectively (P <.001).

On the other hand, there were no significant differences between the arms in the rates of emergency department visits, unplanned hospitalizations or readmissions, average length of hospital stay, chemotherapy dose modifications/discontinuations, or overall survival.

“In this randomized clinical trial, integration of GA [geriatric assessment]-driven MDT interventions into oncology care was a clinically meaningful model that led to significant reductions in grade 3 or higher chemotherapy-related toxic effects and improved AD [advance directive] completion among older adults with cancer receiving chemotherapy,” the study authors wrote.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Li D, Sun CL, 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. Published online September 30, 2021. doi:10.1001/jamaoncol.2021.4158