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25-10-2021 | Oncology | News | Article

Chemotherapy-related toxic effects reduced with geriatric assessment-driven intervention

Hannah Kitt

medwireNews: A geriatric assessment-driven intervention (GAIN) may reduce the risk for grade 3 or higher chemotherapy-related toxicities in older people with cancer, research suggests.

“The [GA] is a comprehensive, validated tool that evaluates physical function, comorbidity, nutritional status, polypharmacy, social support, cognition, and psychological status,” explain Daneng Li (City of Hope Comprehensive Cancer Center, Duarte, California, USA) and colleagues, adding that interventions based on GA findings “can reduce mortality, hospitalizations, and functional decline in the general older adult population.”

However, the impact of GAIN “on chemotherapy-related toxic effects remains unknown,” they say.

The team therefore recruited 605 individuals with a solid tumor who were at least 65 years of age (median 71 years) and had completed a geriatric assessment before starting a new chemotherapy regimen at the City of Hope Comprehensive Cancer Center. The majority of patients were women (59.0%) and had stage IV disease (71.4%). The most common malignancies were gastrointestinal (33.4%), breast (22.5%), lung (16.0%), genitourinary (15.0%), and gynecologic (8.9%) cancers.

A total of 402 patients were randomly assigned to the GAIN arm where a multidisciplinary team of an oncologist, nurse practitioner, social worker, physical therapist, occupational therapist, nutritionist, and pharmacist reviewed the GA and recommended interventions and referrals. After a median follow-up of 85 days, 3971 potential interventions were recommended, at a mean of 10 per patient, with 76.8% being implemented.

The remaining 203 participants instead received standard of care (SOC), which involved their treating oncologists receiving the GA results without any input from the multidisciplinary team. This group was followed up for a median of 80 days, during which 2029 potential interventions were identified by the study authors, also at a mean of 10 per patient, but only 12.5% were implemented by the treating oncologist.

Overall, patients in the GAIN group experienced significantly fewer grade 3 or higher chemotherapy-related toxic effects than those in the SOC group, at rates of 50.5% and 60.6%, respectively, during follow-up, equating to a 10.1 percentage point difference.

GAIN was associated with significant reductions in the incidence of hematologic and nonhematologic adverse events relative to SOC, with between-group differences of 8.0 and 8.2 percentage points, respectively.

A significantly higher proportion of patients in the GAIN than SOC arm completed advance directives by the end of the study, at 74.6% versus 62.1%, despite similar rates of completion at baseline.

There were, however, no significant differences between the groups in terms of emergency department visits, unplanned hospitalizations, unplanned readmissions, average length of stay, chemotherapy dose modifications or discontinuations, and overall survival.

The researchers therefore conclude in JAMA Oncology that GAIN “should be included as a part of standard care for all older adults with cancer.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Oncol 2021; doi:10.1001/jamaoncol.2021.4158

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