Implementing a Geriatric Assessment in Cooperative Group Clinical Cancer Trials: CALGB 360401

Hurria, Arti; Cirrincione, Constance; Muss, Hyman B.; Kornblith, Alice B.; Barry, William T.; Artz, Andrew S.; Schmieder, Linda E.; Ansari, Rafat; Tew, William P.; Weckstein, Douglas; Kirshner, Jeffrey; Togawa, Kayo; Hansen, Katherine; Katheria, Vani; Stone, Richard; Galinsky, Ilene; Postiglione, John; Cohen, Harvey Jay

doi:10.1200/jco.2010.30.6985

Cited by 328 publications

(215 citation statements)

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“…In particular, the median time to completion of the paper-and-pencil version in this study was 15 minutes (range, 9 to 29 minutes) compared with a median time of 15 minutes (range, 3 to 45 minutes) in a prior study of older adults enrolled in cooperative group trials. 3 The results for SupportScreen are not significantly different (median, 16 minutes [range, 6 to 38 minutes]), although REDCap took longer. These findings are not surprising because SupportScreen was developed as an interface to be completed by patients.…”

Section: Discussionmentioning

confidence: 95%

“…Although the intrascale reliability has been established elsewhere, we confirmed the reliability in the context of the geriatric assessment. 3 Alpha coefficient values for the five scales are listed in Table 2. All reliability coefficients are .…”

Section: Reliability and Validitymentioning

confidence: 99%

“…3,4,8 The geriatric assessment consists of a portion completed by the patient, as well as a brief portion completed by the provider. This study focused on the feasibility of using computer methodology for the patient portion of the assessment.…”

Section: Geriatric Assessment Toolmentioning

confidence: 99%

“…3 This geriatric assessment is completed by the patient using paper and pencil. Previous studies have demonstrated that the majority of older adults with cancer receiving standard-of-care treatment 4 or enrolled in a cooperative group clinical trial 3 can complete the patient portion of the geriatric assessment on their own.…”

Section: Introductionmentioning

confidence: 99%

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Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer

Hurria

Akiba

Kim

et al. 2016

JOP

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QUESTION ASKED: Does a computer-based approach for collecting geriatric assessment information provide a practical and efficient means of obtaining reliable and reproducible data from older adults with cancer?SUMMARY ANSWER: Computer-based geriatric assessment provides a feasible, reliable, and valid approach in older adults with cancer. WHAT WE DID:Older patients ($ 65 years) with cancer were randomly assigned to one of four treatment arms to compare the feasibility, reliability, and validity of two computer-based platforms for geriatric assessment with traditional paper-and-pencil data capture.WHAT WE FOUND: Completion times were similar for computer-based and paper-and-pencil assessments (Fig), and data gathered via computer-based assessment showed high test-retest reliability as well as internal consistency. BIAS, CONFOUNDING FACTOR(S), REAL-LIFE IMPLICATIONS:Many of the patients in our study were white, non-Hispanic, and college-educated older adults. This patient population may be more comfortable using computer technologies than other demographic groups; thus our results may not be generalizable to other segments of the patient population. Older patients with cancer are at increased risk for treatment toxicity. Geriatric assessment captures a range of physiological and psychological metrics that predict toxicity and survival, and thus have high utility in guiding interventions. In the current study, we found that computer-based geriatric assessment provides an efficient method for acquiring reliable and valid data. Adoption of computer-based geriatric assessment into oncology practice thus can provide a cost-and time-efficient approach for acquiring high-value data to be used in formulating treatment decisions for older adults with cancer. Completion Time (minutes) Abstract PurposeThe goal of this study was to evaluate the feasibility, reliability, and validity of a computerbased geriatric assessment via two methods of electronic data capture (SupportScreen and REDCap) compared with paper-and-pencil data capture among older adults with cancer. MethodsEligible patients were $ 65 years old, had a cancer diagnosis, and were fluent in English.Patients were randomly assigned to one of four arms, in which they completed the geriatric assessment twice: (1) REDCap and paper and pencil in sessions 1 and 2; (2) REDCap in both sessions; (3) SupportScreen and paper and pencil in sessions 1 and 2; and (4) SupportScreen in both sessions. The feasibility, reliability, and validity of the computer-based geriatric assessment compared with paper and pencil were evaluated. ResultsThe median age of participants (N = 100) was 71 years (range, 65 to 91 years) and the diagnosis was solid tumor (82%) or hematologic malignancy (18% ). There were no significant differences in completion times between SupportScreen and paper and pencil (P = .50). The computer-based geriatric assessment was feasible. Few participants (8%) needed help with completing the geriatric assessment (REDCap, n = 7 and SupportScreen, n = 1), 89% reported th...

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Section: Discussionmentioning

confidence: 95%

Section: Reliability and Validitymentioning

confidence: 99%

Section: Geriatric Assessment Toolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer

Hurria

Akiba

Kim

et al. 2016

JOP

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“…8,9,87 We recommend mailing the self-administered portions of the geriatric assessment to patients before their appointment so they can complete these at home to limit disruptions to clinic workflow and to allow patients to complete the geriatric assessment at their leisure. If they are unable to complete the assessment at home, patients can complete these in the clinic while waiting to be seen by their oncologist.…”

Section: Geriatric Assessment For Radiation and Surgical Oncologymentioning

confidence: 99%

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Loh

Soto‐Pérez‐de‐Celis

Hsu

et al. 2018

JOP

134

105

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Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. CASE J.K. is a 73-year-old man who presented to his primary care physician complaining of bright red blood per rectum. He has a medical history of coronary artery disease, hypertension, hyperlipidemia, and cerebrovascular disease. He is on aspirin, lisinopril, metoprolol, and atorvastatin. A subsequent colonoscopy revealed a 3-cm mass in his descending colon. Biopsy of the mass showed invasive adenocarcinoma. He underwent computed tomography scans of the chest, abdomen, and pelvis, which showed no evidence of metastases. A laparoscopic colectomy was performed, and his cancer was staged as T2N2 (stage III) and microsatellite stable. He is referred to you to discuss adjuvant chemotherapy.

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Geriatric Assessment–Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer

et al. 2021

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Although geriatric assessment-driven intervention improves patient-centered outcomes, its influence on chemotherapy-related toxic effects remains unknown.OBJECTIVE To assess whether specific geriatric assessment-driven intervention (GAIN) can reduce chemotherapy-related toxic effects in older adults with cancer. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial enrolled 613 participants from a National Cancer Institute-designated cancer center between 2015 and 2019. Patients were 65 years and older with a solid malignant neoplasm, were starting a new chemotherapy regimen, and completed a geriatric assessment. Patients were followed up until chemotherapy completion or 6 months after initiation, whichever occurred first. Data analysis was done by intention-to-treat principle.INTERVENTIONS Patients were randomized (2:1) to either the GAIN (intervention) or standard of care (SOC) arm. In the GAIN arm, a geriatrics-trained multidisciplinary team composed of an oncologist, nurse practitioner, social worker, physical/occupation therapist, nutritionist, and pharmacist reviewed geriatric assessment results and implemented interventions based on prespecified thresholds built into the geriatric assessment's domains. In the SOC arm, geriatric assessment results were sent to treating oncologists for consideration. MAIN OUTCOMES AND MEASURESThe primary outcome was incidence of grade 3 or higher chemotherapy-related toxic effects (graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0). Secondary outcomes included advance directive completion, emergency department visits, unplanned hospitalizations, average length of stay, unplanned hospital readmissions, chemotherapy dose modifications, and early discontinuation. Overall survival analysis was performed up to 12 months after chemotherapy initiation. RESULTS Among the 605 eligible participants for analysis, median (range) age was 71 (65-91) years, 357 (59.0%) were women, and 432 (71.4%) had stage IV disease. Cancer types included gastrointestinal (202 [33.4%]), breast (136 [22.5%]), lung (97 [16.0%]), genitourinary (91 [15.0%]), gynecologic (54 [8.9%]), and other (25 [4.1%]). Incidence of grade 3 or higher chemotherapy-related toxic effects was 50.5% (95% CI, 45.6% to 55.4%) in the GAIN arm and 60.6% (95% CI, 53.9% to 67.3%) in the SOC arm, resulting in a significant 10.1% reduction (95% CI, −1.5 to −18.2%; P = .02). A significant absolute increase in advance directive completion of 28.4% with GAIN vs 13.3% with SOC (P < .001) was observed. No significant differences were observed in emergency department visits, unplanned hospitalizations, average length of stay, unplanned readmissions, chemotherapy dose modifications or discontinuations, or overall survival. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, integration of multidisciplinary GAIN significantly reduced grade 3 or higher chemotherapy-related toxic effects in older adults with cancer. Implementation of GAIN into oncology clinical practice should be con...

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Implementing a Geriatric Assessment in Cooperative Group Clinical Cancer Trials: CALGB 360401

Cited by 328 publications

References 48 publications

Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer

Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Geriatric Assessment–Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer

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