Suzanne Festen1, Hanneke van der Wal-Huisman2, Annya H D van der Leest3, Anna K L Reyners4, Geertruida H de Bock5, Pauline de Graeff6, Barbara L van Leeuwen7. 1. University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: s.festen@umcg.nl. 2. University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: h.van.der.wal-huisman@umcg.nl. 3. University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: a.h.d.van.der.leest@umcg.nl. 4. University of Groningen, University Medical Center Groningen, Department of Medical Oncology and Department of Internal Medicine, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: a.k.l.reyners@umcg.nl. 5. University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: g.h.de.bock@umcg.nl. 6. University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: p.de.graeff@umcg.nl. 7. University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Hanzeplein 1, 9700 RB Groningen, the Netherlands. Electronic address: b.l.van.leeuwen@umcg.nl.
Abstract
OBJECTIVES: Decision-making in older patients with cancer can be complex, as benefits of treatment should be weighed against possible side-effects and life-expectancy. A novel care pathway was set up incorporating geriatric assessment into treatment decision-making for older cancer patients. Treatment decisions could be modified following discussion in an onco-geriatric multidisciplinary team (MDT). We assessed the effect of treatment modifications on outcomes. MATERIALS AND METHODS: This retrospective study was performed in the surgical department of a University Hospital. Patients of 70 years and older with a solid malignancy were included. All patients underwent a nurse-led geriatric assessment (GA) and were discussed in an onco-geriatric MDT. This could result in a modified or an unchanged treatment advice compared to the regular tumor board. Primary outcome was one-year mortality. Secondary outcomes were post-operative complications and days spent in hospital in the first year after inclusion. RESULTS: For the 184 patients in the analyses, the median age was 77.5 years and 41.8% were female. For 46 patients (25%), the treatment advice was modified by the onco-geriatric MDT. There was no significant difference in one-year mortality between the unchanged and modified group (29.7% versus 26.1%, p = 0.7). There were, however, significantly fewer days spent in hospital (median 5 vs 8.5 days p = 0.02) and fewer grade II or higher postoperative complications (13.3% versus 35.5% p = 0.005) in the modified group. CONCLUSION: Incorporating geriatric assessment in decision-making did not lead to excess one-year mortality, but did result in fewer complications and days spent in hospital.
OBJECTIVES: Decision-making in older patients with cancer can be complex, as benefits of treatment should be weighed against possible side-effects and life-expectancy. A novel care pathway was set up incorporating geriatric assessment into treatment decision-making for older cancerpatients. Treatment decisions could be modified following discussion in an onco-geriatric multidisciplinary team (MDT). We assessed the effect of treatment modifications on outcomes. MATERIALS AND METHODS: This retrospective study was performed in the surgical department of a University Hospital. Patients of 70 years and older with a solid malignancy were included. All patients underwent a nurse-led geriatric assessment (GA) and were discussed in an onco-geriatric MDT. This could result in a modified or an unchanged treatment advice compared to the regular tumor board. Primary outcome was one-year mortality. Secondary outcomes were post-operative complications and days spent in hospital in the first year after inclusion. RESULTS: For the 184 patients in the analyses, the median age was 77.5 years and 41.8% were female. For 46 patients (25%), the treatment advice was modified by the onco-geriatric MDT. There was no significant difference in one-year mortality between the unchanged and modified group (29.7% versus 26.1%, p = 0.7). There were, however, significantly fewer days spent in hospital (median 5 vs 8.5 days p = 0.02) and fewer grade II or higher postoperative complications (13.3% versus 35.5% p = 0.005) in the modified group. CONCLUSION: Incorporating geriatric assessment in decision-making did not lead to excess one-year mortality, but did result in fewer complications and days spent in hospital.
Authors: Sarah A Wall; Erin Stevens; Jennifer Vaughn; Naresh Bumma; Ashley E Rosko; Uma Borate Journal: Curr Hematol Malig Rep Date: 2022-01-13 Impact factor: 4.213
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