Ryan D Nipp1, Brandon Temel1, Charn-Xin Fuh1, Paul Kay1, Sophia Landay1, Daniel Lage1, Esteban Franco-Garcia2, Erin Scott2, Erin Stevens2, Terrence O'Malley2,3, Supriya Mohile4, William Dale5, Lara Traeger6, Ardeshir Z Hashmi7, Vicki Jackson2, Joseph A Greer6, Areej El-Jawahri1, Jennifer S Temel1. 1. 1Department of Medicine, Division of Hematology and Oncology, and. 2. 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 3. 3Partners Continuing Care, Partners HealthCare System, Boston, Massachusetts. 4. 4Department of Medicine, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, New York. 5. 5Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California. 6. 6Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and. 7. 7Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. METHODS: Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. RESULTS: From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38). CONCLUSIONS: In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.
BACKGROUND: Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. METHODS: Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. RESULTS: From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38). CONCLUSIONS: In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.
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Authors: Ryan D Nipp; Carolyn L Qian; Helen P Knight; Cristina R Ferrone; Hiroko Kunitake; Carlos Fernandez-Del Castillo; Michael Lanuti; Motaz Qadan; Rocco Ricciardi; Keith D Lillemoe; Brandon Temel; Ardeshir Z Hashmi; Erin Scott; Erin Stevens; Grant R Williams; Zhi Ven Fong; Terrence A O'Malley; Esteban Franco-Garcia; Nora K Horick; Vicki A Jackson; Joseph A Greer; Areej El-Jawahri; Jennifer S Temel Journal: J Geriatr Oncol Date: 2022-01-21 Impact factor: 3.929
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