Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

Soo, Wee Kheng; King, Madeleine; Pope, Alun; Parente, Phillip; Dārziņš, Pēteris; Davis, Ian D.

doi:10.1016/s2666-7568(22)00169-6

Cited by 91 publications

(52 citation statements)

References 37 publications

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“…Recently, the GAP70+ and the Geriatric Assessment-Driven Intervention (ie, GAIN) studies showed that older patients with cancer receiving systemic anticancer therapy who were randomised to oncogeriatric care exhibited significantly lower rates of severe toxicities than did those patients who received usual care. 1,2 In the Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) randomised controlled trial published in The Lancet Healthy Longevity, Wee Kheng Soo and colleagues 3 showed that the provision of comprehensive geriatric assessment (CGA) also improves quality of life and health-care delivery for this specific population. Specifically, participants assigned to integrated oncogeriatric care reported better quality of life, measured by the Elderly Functional Index, over 24 weeks compared with those in the usual care group (overall main effect of group: t=2•1, df=213, p=0•039; effect size=0•38).…”

Section: Integrating What Matters To Patients In the Care Of Older Ad...mentioning

confidence: 99%

Integrating what matters to patients in the care of older adults with cancer

Murphy¹,

Battisti²

2022

The Lancet Healthy Longevity

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Section: Integrating What Matters To Patients In the Care Of Older Ad...mentioning

confidence: 99%

Integrating what matters to patients in the care of older adults with cancer

Murphy¹,

Battisti²

2022

The Lancet Healthy Longevity

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“… 63 , 64 The smaller INTEGERATE trial reported lower chemotherapy discontinuation rates with integrated GA-guided oncogeriatric care compared with usual care (33% vs 53%). 65 In a RCT in colorectal cancer patients with tumor surgery followed by chemotherapy (GERICO), 66 more patients in the oncogeriatric intervention arm completed scheduled chemotherapy compared with patients of the control arm (45% vs 28%). More details for RCTs examining GA with or without geriatric management are shown in Table 6 .…”

Section: Frailty Evaluation and Interventions In Older Cancer Patientsmentioning

confidence: 99%

Section: Utility Of Geriatric Assessmentmentioning

confidence: 99%

Frailty and Cancer: Current Perspectives on Assessment and Monitoring

Goede¹

2023

CIA

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Frailty, an age-related condition of increased vulnerability to acute endogenous or exogenous stressors, is a key barrier to successful treatment of cancer in older people. In this group of patients, assessment of frailty is required before starting a new treatment. According to guidelines, the gold standard to assess frailty in older adults with cancer is geriatric screening followed by geriatric assessment (GA) across essential GA-domains (social status, physical function, nutrition, cognition, emotion, co-morbidity, polypharmacy). GA enables tailoring of both oncological therapy and non-oncological interventions to the patient’s vulnerabilities. Large clinical trials recently have demonstrated that the feasibility and tolerability of systemic cancer treatment in older patients are significantly improved by such GA-guided management. Indications and optimal tools for frailty monitoring during the course of cancer treatment have not yet been defined in greater detail. New technologies such as wearable sensors or apps offer promising new opportunities to further develop frailty monitoring. This review describes the current standards and perspectives for the assessment and monitoring of frailty in elderly patients with cancer.

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“…84 More recently, an RCT involving 154 older patients with solid cancer or diffuse large B-cell lymphoma planned for oncology therapy demonstrated that CGA led to better quality of life and lower unplanned admissions compared to usual care. 85 Studies favoring CGA are not unanimous in oncology. For example, an RCT investigating the use of CGA to decrease post-operative delirium or death in older patients undergoing elective surgery for solid cancer failed to show benefits.…”

Section: Oncogeriatric Servicementioning

confidence: 99%

“…86 Although some debate remains, a growing body of literature supports the use of CGA to improve prognostication and decision-making in cancer treatment in older patients. [84][85][86][87]…”

Section: Oncogeriatric Servicementioning

confidence: 99%

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings

Roma

Garção²,

Covinsky³

et al. 2022

Geriatr Gerontol Aging

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Comprehensive geriatric assessment (CGA) is a systematic multidimensional and interdisciplinary evaluation that enables clinicians to recognize age-related impairments and develop a coordinated treatment plan and follow-up suited to the patient's needs. Considering the growing number of older persons requiring care in health systems everywhere and the importance of shifting from a disease-specific care model to a more comprehensive care model, we aimed to present the benefits of CGA for older people in different healthcare settings using a narrative review. This patient-centered model of care has been associated with lower hospital (re)admission, maintenance of function, improved quality of life, less caregiver burden, and higher patient satisfaction with the care provided across different healthcare settings. In some contexts — for example, hospitalized older people —, CGA has already been established as the standard model of care as it was consistently related to reduced mortality. Consistent findings from specific contexts (eg, oncology, orthopaedics) also show the importance of CGA in aiding clinicians make better decisions for older patients. It is noteworthy that further evidence from cost-effectiveness studies is still warranted, particularly in community settings. Another encouraging topic for future research is the role of technology in disseminating CGA-based models of care.

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Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

Cited by 91 publications

References 37 publications

Integrating what matters to patients in the care of older adults with cancer

Integrating what matters to patients in the care of older adults with cancer

Frailty and Cancer: Current Perspectives on Assessment and Monitoring

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings

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