Catherine Handforth1,2, Roger Burkinshaw3, Jenny Freeman3, Janet E Brown3,4, John A Snowden3,5, Robert E Coleman3,4, Diana M Greenfield3,4. 1. University of Sheffield, Sheffield, UK. C.Handforth@sheffield.ac.uk. 2. Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield, S10 2SJ, UK. C.Handforth@sheffield.ac.uk. 3. University of Sheffield, Sheffield, UK. 4. Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield, S10 2SJ, UK. 5. Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, S10 2JF, UK.
Abstract
PURPOSE: In older cancer patients, treatment decision-making is often complex. A comprehensive geriatric assessment (CGA) is an established tool used in geriatric medicine to identify unmet need requiring intervention. This study aimed to assess whether using a CGA in older male cancer patients with incurable but manageable disease provides information that would alter a cancer clinician's intended management plan. Acceptability and feasibility were secondary aims. METHODS: Elderly men with incurable but manageable malignancies (advanced prostate cancer and multiple myeloma) who had previously received at least one line of treatment were recruited from hospital outpatient clinics. A CGA was undertaken. Additional parameters measuring pain, fatigue and disease-specific concerns were also recorded, at the recommendation of patient involvement groups. Results were made available to clinicians. Patient and clinician acceptability and changes in subsequent management were recorded. RESULTS: Forty-eight patients completed the study. The median ages were 70.8 years and 74 years for myeloma and prostate respectively. Most identified concerns are related to disease-specific concerns (93%), pain (91%), frailty (57%) and nutrition (52%). Results altered the clinician's oncological management plan in nine cases only. Patients found the format and content of CGA acceptable. CONCLUSIONS: Many unmet needs were identified in this population of elderly men with manageable but non curable cancer which led to supportive care referrals and interventions. The CGA, however, did not result in significant changes in clinical oncology treatment plans for the majority of patients. The application of the CGA and other assessments was viewed positively by participants and can feasibly be undertaken in the outpatient oncology setting.
PURPOSE: In older cancer patients, treatment decision-making is often complex. A comprehensive geriatric assessment (CGA) is an established tool used in geriatric medicine to identify unmet need requiring intervention. This study aimed to assess whether using a CGA in older male cancer patients with incurable but manageable disease provides information that would alter a cancer clinician's intended management plan. Acceptability and feasibility were secondary aims. METHODS: Elderly men with incurable but manageable malignancies (advanced prostate cancer and multiple myeloma) who had previously received at least one line of treatment were recruited from hospital outpatient clinics. A CGA was undertaken. Additional parameters measuring pain, fatigue and disease-specific concerns were also recorded, at the recommendation of patient involvement groups. Results were made available to clinicians. Patient and clinician acceptability and changes in subsequent management were recorded. RESULTS: Forty-eight patients completed the study. The median ages were 70.8 years and 74 years for myeloma and prostate respectively. Most identified concerns are related to disease-specific concerns (93%), pain (91%), frailty (57%) and nutrition (52%). Results altered the clinician's oncological management plan in nine cases only. Patients found the format and content of CGA acceptable. CONCLUSIONS: Many unmet needs were identified in this population of elderly men with manageable but non curable cancer which led to supportive care referrals and interventions. The CGA, however, did not result in significant changes in clinical oncology treatment plans for the majority of patients. The application of the CGA and other assessments was viewed positively by participants and can feasibly be undertaken in the outpatient oncology setting.
Authors: Arti Hurria; Supriya Gupta; Marjorie Zauderer; Enid L Zuckerman; Harvey J Cohen; Hyman Muss; Miriam Rodin; Katherine S Panageas; Jimmie C Holland; Leonard Saltz; Mark G Kris; Ariela Noy; Jorge Gomez; Ann Jakubowski; Clifford Hudis; Alice B Kornblith Journal: Cancer Date: 2005-11-01 Impact factor: 6.860
Authors: Hans Wildiers; Pieter Heeren; Martine Puts; Eva Topinkova; Maryska L G Janssen-Heijnen; Martine Extermann; Claire Falandry; Andrew Artz; Etienne Brain; Giuseppe Colloca; Johan Flamaing; Theodora Karnakis; Cindy Kenis; Riccardo A Audisio; Supriya Mohile; Lazzaro Repetto; Barbara Van Leeuwen; Koen Milisen; Arti Hurria Journal: J Clin Oncol Date: 2014-08-20 Impact factor: 44.544
Authors: Jean-Pierre Droz; Matti Aapro; Lodovico Balducci; Helen Boyle; Thomas Van den Broeck; Paul Cathcart; Louise Dickinson; Eleni Efstathiou; Mark Emberton; John M Fitzpatrick; Axel Heidenreich; Simon Hughes; Steven Joniau; Michael Kattan; Nicolas Mottet; Stéphane Oudard; Heather Payne; Fred Saad; Toru Sugihara Journal: Lancet Oncol Date: 2014-08 Impact factor: 41.316
Authors: John A Snowden; Diana M Greenfield; Jennifer M Bird; Elaine Boland; Stella Bowcock; Abigail Fisher; Eric Low; Monica Morris; Kwee Yong; Guy Pratt Journal: Br J Haematol Date: 2017-01-20 Impact factor: 6.998