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CHICAGO – Elderly cancer patients have better communication with their oncologists and report greater satisfaction with their care when the oncologists are provided with geriatric assessment summaries prior to the patient visit.
Although “satisfaction” can be subjective, the conclusion about the benefit of previsit geriatric assessments is objective, reported Supriya Gupta Mohile, MD, of the University of Rochester, New York.
“Physicians often don’t know patients’ and caregivers’ age-related concerns, such as concerns about memory or concerns about falling. Many patients and caregivers do not ask about age-related concerns, because of their unclear understanding of the relevance of those issues to an oncology clinical encounter,” she added.
The aim of the researchers was to see whether communication between physicians and their elderly patients could be improved, and patient support needs addressed, with the aid of the Geriatric Assessment (GA), a multidisciplinary diagnostic and treatment instrument.
The GA evaluates patients in the domains of functional status, objective physical performance, comorbidities, cognition, nutritional status, psychological status, and social support, and identifies vulnerabilities that could be addressed by specific interventions.
For example, patients with suboptimal physical performance may trigger recommendations for fall prevention and a review of medications that could increase fall risk. For patients with decrements in functional status, recommendations may include physical therapy, safety evaluation, and/or vision assessment.
Each domain independently predicts morbidity and/or mortality in older patients.
The investigators enrolled 31 oncology practices in the National Cancer Institute’s Community Oncology Research Program that were treating patients aged 70 or older with advanced solid tumors or lymphoma. Patients who were enrolled had at least one impaired GA domain. In all, 542 patients across the sites were enrolled.
All patients in each arm completed the GA.
Randomization was by practice, with practices in arm 1 randomized to receive GA intervention results. Oncologists in this trial arm were provided with a GA summary and list of recommended GA-guided interventions.
Practices in arm 2 (controls) did not receive summaries or lists of recommendations, but oncologists were notified if patients had clinically significant depression or cognitive impairment.
In the intervention group, patients completed all assessments within 30 minutes, and less than 10 minutes of practice staff time was required for administration of objective tests.
The investigators made audio recordings and transcripts of clinic visits after GA in both arms, with two blinded coders evaluating quality of communication and plans for follow-up interventions. Patients were surveyed by telephone about their satisfaction, via the Health Care Climate Questionnaire (HCCQ) and the same instrument modified for age-related concerns (HCCQ-age).
“We found that patients enrolled in the study had a high prevalence of impairments of Geriatric Assessment domains, ranging from over 90% for physical performance, to 25% for psychological status, mainly depression. Of note, more than 30% of patients ... screened positive for cognitive impairment.” Dr. Mohile said.
For the coprimary endpoint of communication about age-related concerns, the mean number of discussions was 7.74 in the GA arm, compared with 4.24 in the control arm, a difference of 3.5 (P less than .0001).
Arm 1 was rated as having more discussions with higher-quality communications (mean 4.42 vs. 2.47, P less than .0001), and had more discussions leading to an intervention (3.08 vs. 1.15, P less than .0001).
Patients in arm 1 consistently rated their satisfaction with communication (the other coprimary endpoint) higher than did patients in arm 2, at both baseline, 4-6 weeks after the visit, and 3 months after the visit.
“This is a very important study that I think is likely to have a direct impact on the care of older patients with cancer,” ASCO expert Joshua A. Jones, MD, of the University of Pennsylvania, Philadelphia, said at the meeting.
“This study shows in a randomized fashion that we can, with a simple intervention, improve communication about what’s really important to older patients with cancer,” he said. “We have interventions, things like physical therapy, things like counseling, supports that can be provided to patients and families as they are thinking through treatment decisions, helping us to provide the most appropriate care for these individuals.”
SOURCE: Mohile SG et al. ASCO 2018, abstract LBA10003.
CHICAGO – Elderly cancer patients have better communication with their oncologists and report greater satisfaction with their care when the oncologists are provided with geriatric assessment summaries prior to the patient visit.
Although “satisfaction” can be subjective, the conclusion about the benefit of previsit geriatric assessments is objective, reported Supriya Gupta Mohile, MD, of the University of Rochester, New York.
“Physicians often don’t know patients’ and caregivers’ age-related concerns, such as concerns about memory or concerns about falling. Many patients and caregivers do not ask about age-related concerns, because of their unclear understanding of the relevance of those issues to an oncology clinical encounter,” she added.
The aim of the researchers was to see whether communication between physicians and their elderly patients could be improved, and patient support needs addressed, with the aid of the Geriatric Assessment (GA), a multidisciplinary diagnostic and treatment instrument.
The GA evaluates patients in the domains of functional status, objective physical performance, comorbidities, cognition, nutritional status, psychological status, and social support, and identifies vulnerabilities that could be addressed by specific interventions.
For example, patients with suboptimal physical performance may trigger recommendations for fall prevention and a review of medications that could increase fall risk. For patients with decrements in functional status, recommendations may include physical therapy, safety evaluation, and/or vision assessment.
Each domain independently predicts morbidity and/or mortality in older patients.
The investigators enrolled 31 oncology practices in the National Cancer Institute’s Community Oncology Research Program that were treating patients aged 70 or older with advanced solid tumors or lymphoma. Patients who were enrolled had at least one impaired GA domain. In all, 542 patients across the sites were enrolled.
All patients in each arm completed the GA.
Randomization was by practice, with practices in arm 1 randomized to receive GA intervention results. Oncologists in this trial arm were provided with a GA summary and list of recommended GA-guided interventions.
Practices in arm 2 (controls) did not receive summaries or lists of recommendations, but oncologists were notified if patients had clinically significant depression or cognitive impairment.
In the intervention group, patients completed all assessments within 30 minutes, and less than 10 minutes of practice staff time was required for administration of objective tests.
The investigators made audio recordings and transcripts of clinic visits after GA in both arms, with two blinded coders evaluating quality of communication and plans for follow-up interventions. Patients were surveyed by telephone about their satisfaction, via the Health Care Climate Questionnaire (HCCQ) and the same instrument modified for age-related concerns (HCCQ-age).
“We found that patients enrolled in the study had a high prevalence of impairments of Geriatric Assessment domains, ranging from over 90% for physical performance, to 25% for psychological status, mainly depression. Of note, more than 30% of patients ... screened positive for cognitive impairment.” Dr. Mohile said.
For the coprimary endpoint of communication about age-related concerns, the mean number of discussions was 7.74 in the GA arm, compared with 4.24 in the control arm, a difference of 3.5 (P less than .0001).
Arm 1 was rated as having more discussions with higher-quality communications (mean 4.42 vs. 2.47, P less than .0001), and had more discussions leading to an intervention (3.08 vs. 1.15, P less than .0001).
Patients in arm 1 consistently rated their satisfaction with communication (the other coprimary endpoint) higher than did patients in arm 2, at both baseline, 4-6 weeks after the visit, and 3 months after the visit.
“This is a very important study that I think is likely to have a direct impact on the care of older patients with cancer,” ASCO expert Joshua A. Jones, MD, of the University of Pennsylvania, Philadelphia, said at the meeting.
“This study shows in a randomized fashion that we can, with a simple intervention, improve communication about what’s really important to older patients with cancer,” he said. “We have interventions, things like physical therapy, things like counseling, supports that can be provided to patients and families as they are thinking through treatment decisions, helping us to provide the most appropriate care for these individuals.”
SOURCE: Mohile SG et al. ASCO 2018, abstract LBA10003.
CHICAGO – Elderly cancer patients have better communication with their oncologists and report greater satisfaction with their care when the oncologists are provided with geriatric assessment summaries prior to the patient visit.
Although “satisfaction” can be subjective, the conclusion about the benefit of previsit geriatric assessments is objective, reported Supriya Gupta Mohile, MD, of the University of Rochester, New York.
“Physicians often don’t know patients’ and caregivers’ age-related concerns, such as concerns about memory or concerns about falling. Many patients and caregivers do not ask about age-related concerns, because of their unclear understanding of the relevance of those issues to an oncology clinical encounter,” she added.
The aim of the researchers was to see whether communication between physicians and their elderly patients could be improved, and patient support needs addressed, with the aid of the Geriatric Assessment (GA), a multidisciplinary diagnostic and treatment instrument.
The GA evaluates patients in the domains of functional status, objective physical performance, comorbidities, cognition, nutritional status, psychological status, and social support, and identifies vulnerabilities that could be addressed by specific interventions.
For example, patients with suboptimal physical performance may trigger recommendations for fall prevention and a review of medications that could increase fall risk. For patients with decrements in functional status, recommendations may include physical therapy, safety evaluation, and/or vision assessment.
Each domain independently predicts morbidity and/or mortality in older patients.
The investigators enrolled 31 oncology practices in the National Cancer Institute’s Community Oncology Research Program that were treating patients aged 70 or older with advanced solid tumors or lymphoma. Patients who were enrolled had at least one impaired GA domain. In all, 542 patients across the sites were enrolled.
All patients in each arm completed the GA.
Randomization was by practice, with practices in arm 1 randomized to receive GA intervention results. Oncologists in this trial arm were provided with a GA summary and list of recommended GA-guided interventions.
Practices in arm 2 (controls) did not receive summaries or lists of recommendations, but oncologists were notified if patients had clinically significant depression or cognitive impairment.
In the intervention group, patients completed all assessments within 30 minutes, and less than 10 minutes of practice staff time was required for administration of objective tests.
The investigators made audio recordings and transcripts of clinic visits after GA in both arms, with two blinded coders evaluating quality of communication and plans for follow-up interventions. Patients were surveyed by telephone about their satisfaction, via the Health Care Climate Questionnaire (HCCQ) and the same instrument modified for age-related concerns (HCCQ-age).
“We found that patients enrolled in the study had a high prevalence of impairments of Geriatric Assessment domains, ranging from over 90% for physical performance, to 25% for psychological status, mainly depression. Of note, more than 30% of patients ... screened positive for cognitive impairment.” Dr. Mohile said.
For the coprimary endpoint of communication about age-related concerns, the mean number of discussions was 7.74 in the GA arm, compared with 4.24 in the control arm, a difference of 3.5 (P less than .0001).
Arm 1 was rated as having more discussions with higher-quality communications (mean 4.42 vs. 2.47, P less than .0001), and had more discussions leading to an intervention (3.08 vs. 1.15, P less than .0001).
Patients in arm 1 consistently rated their satisfaction with communication (the other coprimary endpoint) higher than did patients in arm 2, at both baseline, 4-6 weeks after the visit, and 3 months after the visit.
“This is a very important study that I think is likely to have a direct impact on the care of older patients with cancer,” ASCO expert Joshua A. Jones, MD, of the University of Pennsylvania, Philadelphia, said at the meeting.
“This study shows in a randomized fashion that we can, with a simple intervention, improve communication about what’s really important to older patients with cancer,” he said. “We have interventions, things like physical therapy, things like counseling, supports that can be provided to patients and families as they are thinking through treatment decisions, helping us to provide the most appropriate care for these individuals.”
SOURCE: Mohile SG et al. ASCO 2018, abstract LBA10003.
REPORTING FROM ASCO 2018
Key clinical point: Geriatric cancer patients may have age-related concerns that they don’t bring up during an oncology visit, but that could affect their care.
Major finding: Patients whose oncologists received geriatric assessment results had significantly more and higher quality discussions of age-related concerns, and were significantly more satisfied with their communications at follow-up.
Study details: Cluster randomized controlled trial comprising 542 patients aged 70 and older from 31 community oncology sites.
Disclosures: The National Cancer Institute funded the study. Dr. Mohile disclosed a consulting/advisory role with Seattle Genetics. Dr. Jones reported no conflicts of interest relevant to the study.
Source: Mohile SG et al. ASCO 2018, abstract LBA10003.