Effects of a perioperative geriatric intervention for older adults with Cancer: A randomized clinical trial

Nipp, Ryan David; Qian, Carolyn L.; Knight, Helen; Ferrone, Cristina R.; Kunitake, Hiroko; Castillo, Carlos Fernández‐del; Lanuti, Michael; Qadan, Motaz; Ricciardi, Rocco; Lillemoe, Keith D.; Temel, Brandon; Hashmi, Ardeshir Z.; Scott, Erin; Stevens, Erin; Williams, Grant R.; Fong, Zhi Ven; O’Malley, Terrence A.; Franco-Garcia, Esteban; Horick, Nora; Jackson, Vicki A.; Greer, Joseph A.; El‐Jawahri, Areej; Temel, Jennifer S.

doi:10.1016/j.jgo.2022.01.001

Cited by 22 publications

(19 citation statements)

References 57 publications

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“…In the RCT conducted by Nipp and co-authors on older patients with GI cancer undergoing surgery, the perioperative geriatric intervention (PERI-OP) did not have a significant impact on ICU use, hospital readmissions or complications. However, in the PP analysis, the subgroup who received PERI-OP as planned experienced significantly shorter postoperative hospital LoS [72].…”

Section: Surgical Settingmentioning

confidence: 87%

“…Among the identified studies, there were 15 RCTs [58,59,[61][62][63][64][65][66][67][68][69][70][71][72][73], 6 observational cohort studies [74][75][76][77][78][79], 3 before-and-after studies [80][81][82], 2 pilot studies [60,83], 1 descriptive comparison study [84], 1 prospective observational study [85] and 1 secondary analysis study (of RCT) [86].…”

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

“…The cancer site considered is colorectal cancer (CRC) in 10 studies [59,60,64,67,75,[77][78][79][80][81]; CRC or esophagogastric cancer in 1 study [82]; gastrointestinal cancer (GI) in 1 study [72]; GI, gastro-urinary (GU) or breast cancer in another study [73]; GI or lung cancer in another study [70]; GI or other sites in another study [74]; GU, bladder, kidney or NSCLC in another study [69]; head and neck, lung, upper GI or CRC in another study [71]; NSCLC in another study [66]; prostate, lung, haematologic, GI, head/neck, bladder, renal and other sites in another study [86]; lymphoma, leukaemia or multiple myeloma in another study [65]; solid cancers in 4 studies [61,63,83,85]; solid cancers or lymphoma in another 4 studies [58,62,68,84] and different malignant neoplasms in another study [76].…”

Section: Neutralmentioning

confidence: 99%

“…The included studies published using data from Europe (12 studies [63,[66][67][68][69]71,75,[77][78][79][80]85]), followed by the USA (9 studies [28,61,62,70,72,83,84,86,90]), Hong Kong (2 studies [59,60]), the UK (2 studies [74,82]), Australia (1 study [58]), Canada (1 study [73]), Japan (1 study [64]) and Singapore (1 study [81]). Four articles were published between 2005 and 2014 [60,63,68,86], ten between 2015 and 2018 [59,64,66,73,74,77,79,[82][83][84] and fifteen between 2019 and 2022 [28,58,61,62,67,…”

Section: Neutralmentioning

confidence: 99%

“…Twenty-three studies included the measures of effectiveness of CGA interventions in terms of clinical outcomes and quality of life, such as Quality-Adjusted Life Years (QALYs) or proxy outcomes, the most recurrent being hospital readmissions and reoperations, LoS, unplanned hospitalisations and ICU or ED admissions (grey rows in Tables 2 and 3) [28,[59][60][61]63,64,[66][67][68][70][71][72][73]75,[77][78][79][80][81][82][83]86,90]. All these measures have been frequently adopted in the literature to rate the cost-effectiveness-in particular, LoS as a proxy measure for resource use [92,93], here interpreted as cost-driven or cost-saving measures, a proxy for the propensity of cost-effectiveness of the specific CGA intervention, since the studies lack of actual cost estimations, with the exemption of the studies by Rao and colleagues [86] and Koh and co-authors [81].…”

Section: Studies Reporting Outcomes Of Cga Interventions: Treatment T...mentioning

confidence: 99%

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Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Zuccarino

Monacelli

Antognoli

et al. 2022

Cancers

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The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.

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Section: Surgical Settingmentioning

confidence: 87%

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

Section: Neutralmentioning

confidence: 99%

Section: Neutralmentioning

confidence: 99%

Section: Studies Reporting Outcomes Of Cga Interventions: Treatment T...mentioning

confidence: 99%

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Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Zuccarino

Monacelli

Antognoli

et al. 2022

Cancers

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Association of Preoperative Medical Consultation With Reduction in Adverse Postoperative Outcomes and Use of Processes of Care Among Residents of Ontario, Canada

et al. 2023

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ImportanceIt is uncertain whether preoperative medical consultation reduces adverse postoperative clinical outcomes.ObjectiveTo investigate the association of preoperative medical consultation with reduction in adverse postoperative outcomes and use of processes of care.Design, Setting, and ParticipantsThis was a retrospective cohort study using linked administrative databases from an independent research institute housing routinely collected health data for Ontario’s 14 million residents, including sociodemographic features, physician characteristics and services, and receipt of inpatient and outpatient care. The study sample included Ontario residents aged 40 years or older who underwent their first qualifying intermediate- to high-risk noncardiac operation. Propensity score matching was used to adjust for differences between patients who did and did not undergo preoperative medical consultation with discharge dates between April 1, 2005, and March 31, 2018. The data were analyzed from December 20, 2021, to May 15, 2022.ExposuresReceipt of preoperative medical consultation in the 4 months preceding the index surgery.Main Outcomes and MeasuresThe primary outcome was 30-day all-cause postoperative mortality. Secondary outcomes included 1-year mortality, inpatient myocardial infarction and stroke, in-hospital mechanical ventilation, length of stay, and 30-day health system costs.ResultsOf the total 530 473 individuals (mean [SD] age, 67.1 [10.6] years; 278 903 [52.6%] female) included in the study, 186 299 (35.1%) received preoperative medical consultation. Propensity score matching resulted in 179 809 well-matched pairs (67.8% of the full cohort). The 30-day mortality rate was 0.9% (n = 1534) in the consultation group and 0.7% (n = 1299) in the control group (odds ratio [OR], 1.19; 95% CI, 1.11-1.29). The ORs for 1 year mortality (OR, 1.15; 95% CI, 1.11-1.19), inpatient stroke (OR, 1.21; 95% CI, 1.06-1.37), in-hospital mechanical ventilation (OR, 1.38; 95% CI, 1.31-1.45), and 30-day emergency department visits (OR, 1.07; 95% CI, 1.05-1.09) were higher in the consultation group; however, the rates of inpatient myocardial infarction did not differ. The lengths of stay in acute care were a mean (SD) 6.0 (9.3) days in the consultation group and 5.6 (10.0) days in the control group (difference, 0.4 [95% CI, 0.3-0.5] days), and the median (IQR) total 30-day health system cost was CAD $317 ($229-$959) (US $235 [$170-$711]) higher in the consultation group. Preoperative medical consultation was associated with increased use of preoperative echocardiography (OR, 2.64; 95% CI, 2.59-2.69) and cardiac stress tests (OR, 2.50; 95% CI, 2.43-2.56) and higher odds of receiving a new prescription for β-blockers (OR, 2.96; 95% CI, 2.82-3.12).Conclusions and RelevanceIn this cohort study, preoperative medical consultation was not associated with a reduction but rather with an increase in adverse postoperative outcomes, suggesting a need for further refinement of target populations, processes, and interventions related to preoperative medical consultation. These findings highlight the need for further research and suggest that referral for preoperative medical consultation and subsequent testing should be carefully guided by individual-level consideration of risks and benefits.

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Ageing and cancer: a research gap to fill

2022

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The complex mechanisms of ageing biology are increasingly understood. Interventions to reduce or delay ageing-associated diseases are emerging. Cancer is one of the diseases promoted by tissue ageing. A clockwise mutational signature is identified in many tumours. Ageing might be a modifiable cancer risk factor. To reduce the incidence of ageing-related cancer and to detect the disease at earlier stages, we need to understand better the links between ageing and tumours. When a cancer is established, geriatric assessment and measures of biological age might help to generate evidencebased therapeutic recommendations. In this approach, patients and caregivers would include the respective weight to give to the quality of life and survival in the therapeutic choices. The increasing burden of cancer in older patients requires new generations of researchers and geriatric oncologists to be trained, to properly address disease complexity in a multidisciplinary manner, and to reduce health inequities in this population of patients. In this review, we propose a series of research challenges to tackle in the next few years to better prevent, detect and treat cancer in older patients while preserving their quality of life.

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Effects of a perioperative geriatric intervention for older adults with Cancer: A randomized clinical trial

Cited by 22 publications

References 57 publications

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Association of Preoperative Medical Consultation With Reduction in Adverse Postoperative Outcomes and Use of Processes of Care Among Residents of Ontario, Canada

Ageing and cancer: a research gap to fill

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