2018 ASCO Annual Meeting!
Session: Patient and Survivor Care
Type: Oral Abstract Session
Time: Sunday June 3, 8:00 AM to 11:00 AM
Improving communication with older patients with cancer using geriatric assessment (GA): A University of Rochester NCI Community Oncology Research Program (NCORP) cluster randomized controlled trial (CRCT).
Patient and Survivor Care
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr LBA10003)
Author(s): Supriya Gupta Mohile, Ronald M. Epstein, Arti Hurria, Charles E. Heckler, Paul Duberstein, Beverly E. Canin, Nikesha Gilmore, Megan Wells, Huiwen Xu, Eva Culakova, Lisa M. Lowenstein, Marie Anne Flannery, Allison Magnuson, Kah Poh Loh, Karen Michelle Mustian, Judith O. Hopkins, Jijun Liu, Nataliya Melnyk, Gary R. Morrow, William Dale; University of Rochester Medical Center, Rochester, NY; University of Rochester, Rochester, NY; City of Hope National Medical Center, Duarte, CA; University of Rochester, Rhinebeck, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; NRG Oncology/NSABP, and SCOR NCORP and the Forsyth Regional Cancer Center, Winston Salem, NC; Illinois Cancer Care, Peoria, IL; Rutgers Robert Wood Johnson Medcl School, East Brunswick, NJ; CIY, Chicago, IL
Background: GA includes validated measures that assess age-related health domains (e.g., function, cognition) known to increase adverse outcomes. In this PCORI and NCI funded CRCT, we evaluated if providing a GA summary and recommendations for GA-guided interventions improves communication about age-related concerns for older patients (pts) with cancer. Methods: Pts aged ≥ 70 with advanced solid tumors or lymphoma and at least 1 impaired GA domain were enrolled. Oncology practices were randomized to intervention (oncologists received GA summary) or usual care (no summary provided). The primary outcomes were: 1) number of discussions about age-related concerns (the clinic visit after GA was audio-recorded and transcribed; 2 blinded coders evaluated quality of communication and plan for follow-up interventions) and 2) telephone surveys of patient satisfaction (modified Health Care Climate Questionnaire [HCCQ-age] scored 7-35). Outcomes were analyzed using linear mixed models with arm as the fixed effect, controlling for practice. Results: From 2014-17, 544 pts (295 in GA) were enrolled from 31 practices. There were no differences in demographics by arm (mean age 77 yrs; 49% female). More patients in usual care had impaired physical performance (96% vs 92%, p = 0.03) and social support (33% vs 25%, p = 0.05). In 530 evaluable pts, the overall mean number of discussions was 6.3 (SD: 4.0). The GA arm had 3.5 more discussions about age-related concerns (95%CI: 2.28-4.72, p = 10-6; intraclass correlation coefficient [ICC] = 0.24) compared to usual care; of these, in the GA arm, 2.0 more discussions on average had higher quality communication (95%CI: 1.20-2.69; p = 6x10-6) and 1.9 more led to interventions (95% CI: 1.14-2.73; p = 1.6x10-5). The GA arm had significantly more discussions for almost all GA domains. In 511 pts with HCCQ-age, the mean score was 22.9 (SD 4.5); the score was 1.12 points higher in the GA arm (95%CI: 0.23-2.03; p = .027; ICC = 0.02). Conclusions: Providing a GA summary to oncologists increases the number and quality of discussions about age-related concerns and improves pt satisfaction. Clinical trial information: NCT02107443