Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium

Kenis, Cindy; Decoster, Lore; Flamaing, Johan; Debruyne, Philip R.; Groof, Inge De; Focan, C.; Cornélis, Frank; Verschaeve, Vincent; Bachmann, Christian; Bron, Dominique; Luce, Sylvie; Debugne, Gwenaëlle; Bulck, Hilde Van den; Goeminne, Jean-Charles; Schrijvers, Dirk; Geboers, Katrien; Petit, Bénédicte; Langenaeken, Christine; Rijswijk, R. Van; Specenier, Pol; Jérusalem, Guy; Praet, Jean Philippe; Vandenborre, K.; Lobelle, Jean-Pierre; Lycke, Michelle; Milisen, Koen; Wildiers, Hans

doi:10.1093/annonc/mdy210

Cited by 53 publications

(49 citation statements)

References 17 publications

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“…These evidence-based recommendations have been shown to improve outcomes such as nutritional status, frailty, and chemotherapy tolerance in older adults [ 8 - 11 ]. Nevertheless, implementation of GA-driven interventions is low in the oncology community [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study

et al. 2018

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BackgroundOlder patients with cancer are at an increased risk of adverse outcomes. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality, and it can be used to guide interventions. However, the implementation of GA and GA-driven interventions is low due to resource and time limitations. GA-driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers.ObjectiveWe aimed to evaluate the feasibility and usability of a novel app (TouchStream) and to identify barriers to its use. As an exploratory aim, we gathered preliminary data on symptom burden, health care utilization, and satisfaction.MethodsIn a single-site pilot study, we included patients aged ≥65 years undergoing treatment for systemic cancer and their caregivers. TouchStream consists of a mobile app and a Web portal. Patients underwent a GA at baseline with the study team (on paper), and the results were used to guide interventions delivered through the app. A tablet preloaded with the app was provided for use at home for 4 weeks. Feasibility metrics included usability (system usability scale of >68 is considered above average), recruitment, retention (number of subjects consented who completed postintervention assessments), and percentage of days subjects used the app. For the last 8 patients, we assessed their symptom burden (severity and interference with 17-items scored from 0-10 where a higher score indicates worse symptoms) using a clinical symptom inventory, health care utilization from the electronic medical records, and satisfaction (6 items scored on a 5-point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction) using a modified satisfaction survey. Barriers to use were elicited through interviews.ResultsA total of 18 patients (mean age 76.8, range 68-87) and 13 caregivers (mean age 69.8, range 38-81) completed the baseline assessment. Recruitment and retention rates were 67% and 80%, respectively. The mean SUS score was 74.0 for patients and 72.2 for caregivers. Mean percentage of days the TouchStream app was used was 78.7%. Mean symptom severity and interference scores were 1.6 and 2.8 at preintervention, and 0.9 and 1.5 at postintervention, respectively. There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period (week 5-8). One patient was hospitalized during the intervention period (week 1-4) and two patients during the postintervention period (week 5-8). Mean satisfaction scores of patients and caregivers with the mobile app were 20.4 and 23.4, respectively. Barriers fell into 3 themes: general experience, design, and functionality.ConclusionsTouchStream is feasible and usable for older patients on cancer treatment and their caregivers. Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion.

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Section: Introductionmentioning

confidence: 99%

Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study

et al. 2018

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“…Although several tools have been developed, they are not routinely used in the urological community [12]. The G8 screening tool could help in calculating the risk of treatment -associated adverse events as well as 90-day morbidity and mortality [13]. In the future, we are going to investigate the utility of the G8 screening as a tool for deciding the type of management in this very old population.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes between Standard and Palliative Management for High Grade Non-Muscle Invasive Bladder Cancer in Patients Older than 85 Years

et al. 2019

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Objectives: To analyze outcomes of patients > 85 years with de novo bladder cancer (BCa). To compare outcomes of high grade (HG) non-muscle invasive BCa (NMIBC) treated with standard therapies versus palliative management. Methods: Retrospective revision of 65 patients > 85 years who underwent transurethral resection of the bladder (TURB) for de novo BCa. According to functional status each patient was offered a standard or palliative management after TURB. Results: Median age was 87.3 years (85.2–95.4) and 51 were men (78.5%). Twenty-eight (43%) were American Society of Anesthesiologists (ASA) II and 37 ASA III–IV (57%). Pathological examination: 29 pTx-pTa (44.6%), 28 pT1 (43.1%) and 8 pT2 (12.3%). Twenty were low grade (30.8%) and 45 HG (69.2%). Among 37 HG NMIBC patients, 43% followed standard therapies (BCG or re-staging TURB + BCG), and 57% a palliative management (no oncological treatments). With a median follow-up of 20 months (3–108), 2 (12.5%) died in standard group compared to 11 (52.4%) in palliative. In univariate analysis, age (p = 0.024), stage (p = 0.009), and standard management (p = 0.019) were related to overall survival (OS). In multivariate, standard management was an independent prognostic factor of OS (hazard ratio 0.164, 95% CI 0.036–0.744, p = 0.048). Conclusions: Advanced age should not be a contraindication for standard therapies in BCa. A geriatric assessment could identify patients who may benefit from adjuvant therapies after TURB.

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“…This cohort study highlights the difficulty of implementing geriatric interventions and of the necessity of follow-up. Recent studies have listed the types of interventions and their implementation, but they did not analyze the factors that can lead to more interventions [13,14]. Baitar et al [16] in 2015 described an adherence of 35.5% to geriatric interventions, and Kenis et al [14] in 2018 adherence of over 40% in the most important domains.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have listed the types of interventions and their implementation, but they did not analyze the factors that can lead to more interventions [13,14]. Baitar et al [16] in 2015 described an adherence of 35.5% to geriatric interventions, and Kenis et al [14] in 2018 adherence of over 40% in the most important domains. These three studies were conducted by the same team and suggest that the increased rate of implementation is obviously due to the learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the CGA has been shown to predict outcomes (chemotherapy toxicity, life expectancy) to help make therapeutic decisions but also provide the best interventions [11,12]. Previous studies have described adherence of geriatric assessment recommendations [13,14] as well as guidelines for practical assessment and management of older patients receiving chemotherapy [6]. Now, the challenge in geriatric oncology is to screen patients who require geriatric follow-up with specific guided interventions.…”

Section: Introductionmentioning

confidence: 99%

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The Desire to Better Understand Older Adults with Solid Tumors to Improve Management: Assessment and Guided Interventions—The French PACA EST Cohort Experience

Boulahssass

Gonfrier

Champigny

et al. 2019

Cancers

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Todays challenge in geriatric oncology is to screen patients who need geriatric follow-up. The main goal of this study was to analyze factors that identify patients, in a large cohort of patients with solid tumors, who need more geriatric interventions and therefore specific follow-up. Between April 2012 and May 2018, 3530 consecutive patients were enrolled in the PACA EST cohort (France). A total of 3140 patients were finally enrolled in the study. A Comprehensive Geriatric Assessment (CGA) was performed at baseline. We analyzed the associations between factors at baseline (geriatric and oncologic factors) and the need to perform more than three geriatric interventions. The mean age of the population was 82 years old with 59% of patients aged older than 80 years old. A total of 8819 geriatric interventions were implemented for the 3140 patients. The percentage of patients with three or more geriatric interventions represented 31.8% (n = 999) of the population. In multivariate analyses, a Mini Nutritional assessment (MNA) <17, an MNA ≤23·5 and ≥17, a performans status (PS) >2, a dependence on Instrumental Activities of Daily Living (IADL), a Geriatric Depression Scale (GDS) ≥5, a Mini Mental State Examination (MMSE) <24, and a Screening tool G8 ≤14 were independent risk factors associated with more geriatric interventions. Factors associated with more geriatric interventions could assist practitioners in selecting patients for specific geriatric follow-up.

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Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium

Cited by 53 publications

References 17 publications

Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study

Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study

Comparison of Outcomes between Standard and Palliative Management for High Grade Non-Muscle Invasive Bladder Cancer in Patients Older than 85 Years

The Desire to Better Understand Older Adults with Solid Tumors to Improve Management: Assessment and Guided Interventions—The French PACA EST Cohort Experience

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