Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study

Mohile, Supriya G.; Mohamed, Mostafa R.; Xu, Huiwen; Culakova, Eva; Loh, Kah Poh; Magnuson, Allison; Flannery, Marie; Obrecht, Spencer; Gilmore, Nikesha; Ramsdale, Erika; Dunne, Richard F.; Wildes, Tanya M.; Plumb, Sandy; Patil, Amita; Wells, Megan; Lowenstein, Lisa M.; Janelsins, Michelle Christine; Mustian, Karen M.; Hopkins, Judith O.; Berenberg, Jeffrey L.; Anthony, Navin; Dale, William

doi:10.1016/s0140-6736(21)01789-x

Cited by 285 publications

(250 citation statements)

References 32 publications

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“…Many of these assumptions were examined in extensive sensitivity analyses and found not to affect our findings. Fourth, we did not explicitly consider a reduction in treatment toxicity or unplanned health care use as benefits of GA. Two recently published RCTs of GA and co-management demonstrated 10-20% reductions in severe toxicity with systemic therapy in the metastatic setting along with reductions in unplanned health care use [6,7]. Incorporating these would have made GA even more cost effective in our study.…”

Section: Strengths and Limitationsmentioning

confidence: 79%

“…GA is associated with the detection of important conditions that are missed during the typical oncologic evaluation and results in a median of 28% of treatment decisions being modified, with about two-thirds of modifications being reductions in treatment intensity [5]. Based on emerging randomized trial evidence, GA and management are associated with reduced unplanned health care service use during cancer treatment [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Economic Evaluation of a Geriatric Oncology Clinic

Alibhai

Alam

Saluja

et al. 2022

Cancers

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Geriatric assessment (GA) is supported by recent trials and guidelines yet rarely implemented due to a lack of resources. We performed an economic evaluation of a geriatric oncology clinic. Pre-GA proposed treatments and post-GA actual treatments were obtained from a detailed chart review of patients seen at a single academic centre. GA-based costs for investigations and referrals were calculated. Unit costs were obtained for surgical, radiation, systemic therapy, laboratory, imaging, physician, nursing, and allied health care (all in 2019 Canadian dollars). A six-month time horizon and government payer perspective were used. Consecutive patients aged 65 years or older (n = 152, mean age 82 y) and referred in the pre-treatment setting between July 2016 and June 2018 were included. Treatment plans were modified for 51% of patients. Costs associated with planned treatment were CAD 3,655,015. Costs associated with GA and related interventions were CAD 95,798. Final treatment costs were CAD 2,436,379. Net savings associated with the clinic were CAD 1,122,837, or CAD 7387 per patient seen. Findings were robust in multiple sensitivity analyses. Combined with mounting trial data demonstrating the clinical benefits of GA, our data can inform a strong business case for geriatric oncology clinics in health care environments similar to ours, but additional studies in diverse health care settings are warranted.

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Section: Strengths and Limitationsmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Economic Evaluation of a Geriatric Oncology Clinic

Alibhai

Alam

Saluja

et al. 2022

Cancers

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“…There was also a significant increase in the completion of advance directives in the GAIN arm (28.4% vs. 13.3%, p < 0.001). Another study by Mohile et al which included 718 patients aged 70 years or older with advanced cancer demonstrated that integration of geriatric interventions into usual care reduced the incidence of grade 3-5 toxicities (51% vs. 71%, p = 0.0001) and incidence of falls (12% vs. 21%, p = 0.0035) (98). These studies demonstrated that the integration of geriatric interventions in cancer management in elderly patients certainly improved the clinical outcome and reduced toxicities.…”

Section: Future Directions-integrating Geriatric Assessment/ Interventions Into the Management Of Npc In Elderliesmentioning

confidence: 99%

Management of Nasopharyngeal Carcinoma in Elderly Patients

Chan

Chow

et al. 2022

Front. Oncol.

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Nasopharyngeal cancer (NPC) is one of the most difficult cancers in the head and neck region due to the complex geometry of the tumour and the surrounding critical organs. High-dose radical radiotherapy with or without concurrent platinum-based chemotherapy is the primary treatment modality. Around 10%–15% of NPC patients have their diagnosis at age after 70. The management of NPC in elderly patients is particularly challenging as they encompass a broad range of patient phenotypes and are often prone to treatment-related toxicities. Chronologic age alone is insufficient to decide on the management plan. Comprehensive geriatric assessment with evaluation on patients’ functional status, mental condition, estimated life expectancy, comorbidities, risks and benefits of the treatment, patients’ preference, and family support is essential. In addition, little data from randomized controlled trials are available to guide treatment decisions in elderly patients with NPC. In deciding which treatment strategy would be suitable for an individual elderly patient, we reviewed the literature and reviewed the analysis of primary studies, reviews, and guidelines on management of NPC. This review also summarises the current evidence for NPC management in elderly adults from early to late stage of disease.

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“…In general, elderly patients often focus on reducing the risk of adverse events and maintaining normal life and quality of life as goals of advanced cancer treatment [ 23 , 24 ]. More recently, Mohile et al reported that providing GA and its management to elderly patients undergoing chemotherapy for advanced solid tumors can help reduce serious adverse events [ 25 ]. In Japan, a clinical trial is underway with the endpoint of improving patient satisfaction and treatment outcomes by providing GA with management in non-small cell lung cancer [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Treatments for elderly cancer patients and reforms to social security systems in Japan

Nagashima

Furuse

2022

Int J Clin Oncol

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In Japan, the population aged 65 years and above accounts for 29% of the total population. Furthermore, the number of cancer patients among the elderly is increasing. Geriatric oncology is a discipline that deals with appropriate care for elderly cancer patients based on their characteristics. The International Society of Geriatric Oncology considers education, treatment, research, and partnership building areas of significance and priority for policy goals. In Japan, the Third Term of the Basic Plan to Promote Cancer Control is an initiative to improve the infrastructure and health services involved in cancer care. Content related to “cancer in the elderly” was added to establish guidelines for treating cancer in the elderly. Thus far, “Clinical Practice Guidelines of Cancer Drug Therapies for the Elderly” have been published. With the increasing age of the population, social security expenditures will increase substantially after the fiscal year 2022. Reforms to social security systems, such as pensions, medical care, and nursing care, are underway. It is important to enhance cooperation between oncology and geriatrics and to support cooperative systems among families and medical professionals to promote geriatric oncology. Since the working-age population and the total population have begun to decline, Japan is facing many challenges. As a leader of a super-aging society, Japan has the potential to share its experience on a global scale and address potential long-term outcomes.

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Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study

Cited by 285 publications

References 32 publications

Economic Evaluation of a Geriatric Oncology Clinic

Economic Evaluation of a Geriatric Oncology Clinic

Management of Nasopharyngeal Carcinoma in Elderly Patients

Treatments for elderly cancer patients and reforms to social security systems in Japan

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