PURPOSE: Older patients with advanced cancer often have comorbidities that can worsen their cancer and treatment outcomes. We assessed how a geriatric assessment (GA)-guided intervention can guide conversations about comorbidities among patients, oncologists, and caregivers. METHODS: This secondary analysis arose from a nationwide, multisite cluster-randomized trial (ClinicalTrials.gov identifier: NCT02107443). Eligible patients were ≥ 70 years, had advanced cancer (solid tumors or lymphoma), and had impairment in at least one GA domain (not including polypharmacy). Oncology practices (n = 30) were randomly assigned to usual care or intervention. All patients completed a GA; in the intervention arm, a GA summary with recommendations was provided to their oncologist. Patients completed an Older Americans Resources and Services Comorbidity questionnaire at screening. The clinical encounter following GA was audio-recorded, transcribed, and coded for topics related to comorbidities. Linear mixed models examined the effect of the intervention on the outcomes adjusting for practice site as a random effect. RESULTS: Patients (N = 541) were 76.6 ± 5.2 years old; 94.6% of patients had at least one comorbidity with an average of 3.2 ± 1.9. The intervention increased the average number of conversations regarding comorbidities per patient from 0.52 to 0.99 (P < .01). Moreover, there were a greater number of concerns acknowledged (0.52 v 0.32; P = .03) and there was a 2.4-times higher odds of having comorbidity concerns addressed via referral, handout, or other modes (95% CI, 1.3 to 4.3; P = .004). Most oncologists in the intervention arm (76%) discussed comorbidities in light of the treatment plan, and 41% tailored treatment plans. CONCLUSION: Providing oncologists with a GA-guided intervention enhanced communication regarding comorbidities.
PURPOSE: Older patients with advanced cancer often have comorbidities that can worsen their cancer and treatment outcomes. We assessed how a geriatric assessment (GA)-guided intervention can guide conversations about comorbidities among patients, oncologists, and caregivers. METHODS: This secondary analysis arose from a nationwide, multisite cluster-randomized trial (ClinicalTrials.gov identifier: NCT02107443). Eligible patients were ≥ 70 years, had advanced cancer (solid tumors or lymphoma), and had impairment in at least one GA domain (not including polypharmacy). Oncology practices (n = 30) were randomly assigned to usual care or intervention. All patients completed a GA; in the intervention arm, a GA summary with recommendations was provided to their oncologist. Patients completed an Older Americans Resources and Services Comorbidity questionnaire at screening. The clinical encounter following GA was audio-recorded, transcribed, and coded for topics related to comorbidities. Linear mixed models examined the effect of the intervention on the outcomes adjusting for practice site as a random effect. RESULTS: Patients (N = 541) were 76.6 ± 5.2 years old; 94.6% of patients had at least one comorbidity with an average of 3.2 ± 1.9. The intervention increased the average number of conversations regarding comorbidities per patient from 0.52 to 0.99 (P < .01). Moreover, there were a greater number of concerns acknowledged (0.52 v 0.32; P = .03) and there was a 2.4-times higher odds of having comorbidity concerns addressed via referral, handout, or other modes (95% CI, 1.3 to 4.3; P = .004). Most oncologists in the intervention arm (76%) discussed comorbidities in light of the treatment plan, and 41% tailored treatment plans. CONCLUSION: Providing oncologists with a GA-guided intervention enhanced communication regarding comorbidities.
Authors: Stuart M Lichtman; Hans Wildiers; Vincent Launay-Vacher; Christopher Steer; Etienne Chatelut; Matti Aapro Journal: Eur J Cancer Date: 2007-01 Impact factor: 9.162
Authors: Lee A Kehoe; Huiwen Xu; Paul Duberstein; Kah Poh Loh; Eva Culakova; Beverly Canin; Arti Hurria; William Dale; Megan Wells; Nikesha Gilmore; Amber S Kleckner; Jennifer Lund; Charles Kamen; Marie Flannery; Mike Hoerger; Judith O Hopkins; Jane Jijun Liu; Jodi Geer; Ron Epstein; Supriya G Mohile Journal: J Am Geriatr Soc Date: 2019-03-29 Impact factor: 5.562
Authors: Jennifer L Patnaik; Tim Byers; Carolyn Diguiseppi; Thomas D Denberg; Dana Dabelea Journal: J Natl Cancer Inst Date: 2011-06-30 Impact factor: 13.506
Authors: Arti Hurria; Stuart M Lichtman; Jonathan Gardes; Daneng Li; Sewanti Limaye; Sujata Patil; Enid Zuckerman; William Tew; Paul Hamlin; Ghassan K Abou-Alfa; Mark Lachs; Eva Kelly Journal: J Am Geriatr Soc Date: 2007-08-14 Impact factor: 5.562
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: Ronald M Epstein; Paul R Duberstein; Joshua J Fenton; Kevin Fiscella; Michael Hoerger; Daniel J Tancredi; Guibo Xing; Robert Gramling; Supriya Mohile; Peter Franks; Paul Kaesberg; Sandy Plumb; Camille S Cipri; Richard L Street; Cleveland G Shields; Anthony L Back; Phyllis Butow; Adam Walczak; Martin Tattersall; Alison Venuti; Peter Sullivan; Mark Robinson; Beth Hoh; Linda Lewis; Richard L Kravitz Journal: JAMA Oncol Date: 2017-01-01 Impact factor: 31.777
Authors: Jennifer L Lund; Paul R Duberstein; Kah Poh Loh; Nikesha Gilmore; Sandy Plumb; Lianlian Lei; Alexander P Keil; Jessica Y Islam; Laura C Hanson; Jeffrey K Giguere; Victor G Vogel; Brian L Burnette; Supriya G Mohile Journal: J Geriatr Oncol Date: 2021-09-02 Impact factor: 3.599
Authors: Courtney P Williams; Amy Davidoff; Michael T Halpern; Michelle Mollica; Kathleen Castro; Benjamin Allaire; Janet S de Moor Journal: JCO Oncol Pract Date: 2022-08
Authors: Marielle Jensen-Battaglia; Lianlian Lei; Huiwen Xu; Lee Kehoe; Amita Patil; Kah Poh Loh; Erika Ramsdale; Allison Magnuson; Amber S Kleckner; Tanya M Wildes; Po-Ju Lin; Karen M Mustian; Gilbert Giri; Mary Whitehead; James Bearden; Brian L Burnette; Jodi Geer; Supriya G Mohile; Richard F Dunne Journal: JAMA Netw Open Date: 2022-03-01