Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials

Magnuson, Allison; Walde, Noam Van der; McKoy, June M.; Wildes, Tanya M.; Wong, Melisa L.; Le‐Rademacher, Jennifer; Little, Richard F.; Klepin, Heidi D.

doi:10.1093/jncimonographs/lgac021

Cited by 12 publications

(8 citation statements)

References 66 publications

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“…Globally, the number of older persons aged 65 years and over is projected to increase [ 1 ]. People aged 65 years and over have been frequently excluded from research (e.g., clinical trials); when included, researchers often do not report analysis by age [ 48 , 49 ]. Our review was not specific to gender, sex, ethnicity, or frailty [ 46 ].…”

Section: Methodsmentioning

confidence: 99%

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review

Camargo-Plazas,

Robertson,

Alvarado

et al. 2023

PLoS ONE

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Diabetes mellitus is a chronic metabolic health condition affecting millions globally. Diabetes is a growing concern among aging societies, with its prevalence increasing among those aged 65 and above. Enabling disease self-management via relevant education is part of high-quality care to improve health outcomes and minimize complications for individuals living with diabetes. Successful diabetes self-management education (DSME) programs usually require tailoring for the intended audience; however, there is limited literature about the preferences of older persons in Western countries concerning DSME. As such, a broad overview of DSME for older persons was an identified need. To map the available evidence on DSME for persons aged 65 years and older in Western countries, the JBI methodology for conducting and reporting scoping reviews was used. In this scoping review, we considered all studies about DSME for older persons with T1D and T2D in Western countries where lifestyles, risks, prevention, treatment of diabetes, and approaches to self-management and DSME are similar (e.g., North America, Western and Northern Europe and Australasia). Systematic keyword and subject heading searches were conducted in 10 databases (e.g., MEDLINE, JBI EBP) to identify relevant English language papers published from 2000 to 2022. Titles and abstracts were screened to select eligible papers for full-text reading. Full-text screening was done by four independent reviewers to select studies for the final analysis. The review identified 2,397 studies, of which 1,250 full texts were screened for eligibility. Of the final 44 papers included in the review, only one included participants’ understanding of DSME. The education programs differed in their context, design, delivery mode, theoretical underpinnings, and duration. Type of research designs, outcome measures used to determine the effectiveness of DSME, and knowledge gaps were also detailed. Overall, most interventions were effective and improved clinical and behavioural outcomes. Many of the programs led to improvements in clinical outcomes and participants’ quality of life; however, the content needs to be adapted to older persons according to their culture, different degrees of health literacy, preference of education (e.g., individualized or group), preference of setting, degree of frailty and independence, and comorbidities. Few studies included the voices of older persons in the design, implementation, and evaluation of DSME programs. Such experiential knowledge is vital in developing educational programs to ensure alignment with this population’s preferred learning styles, literacy levels, culture, and needs—such an approach could manifest more substantive, sustained results.

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Section: Methodsmentioning

confidence: 99%

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review

Camargo-Plazas,

Robertson,

Alvarado

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

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“…Perhaps there are better times in the course of disease-times of recurrence or when a therapeutic change is considered or after toxicity-that would also be important. 76 Additionally, the strongest evidence supporting the use of GA and GAM is not fully representative of those who most often get cancer. The accrual of older adults into clinical trials remains well below their representation as patients with cancer.…”

Section: Gaps In the Literature And Future Research Directionsmentioning

confidence: 99%

“…Perhaps there are better times in the course of disease—times of recurrence or when a therapeutic change is considered or after toxicity—that would also be important. 76…”

Section: Gaps In the Literature And Future Research Directionsmentioning

confidence: 99%

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

Dale

Klepin

Williams

et al. 2023

JCO

Self Cite

103

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PURPOSE To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy. METHODS An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022. RESULTS A total of 26 publications met eligibility criteria and form the evidentiary basis for the update. RECOMMENDATIONS The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate. The Panel recommends the Practical Geriatric Assessment as one option for this purpose ( https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf ; https://youtu.be/jnaQIjOz2Dw ; https://youtu.be/nZXtwaGh0Z0 ). Additional information is available at www.asco.org/supportive-care-guidelines .

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“…For example, one recent study demonstrated that sarcopenia was associated with an increased risk of ICANS and longer length of hospital stay. 83 Consistently gathering additional data (including geriatric assessment) 84,85 about the baseline health of individuals enrolled in clinical trials of CAR T-cell and BsAbs will improve clinicians' insight into whether their patients are similar to those treated on trial and identify those who may be at increased risk for toxicity, allowing more informed shared decision making.…”

Section: Access To Care and Equity In Real-world Settingsmentioning

confidence: 99%

Chimeric Antigen Receptor T-Cell and Bispecific Antibody Therapy in Multiple Myeloma: Moving Into the Future

Holstein

Grant

Wildes

2023

JCO

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Historically, the outcomes for individuals with triple-class refractory and penta-drug refractory multiple myeloma (MM) have been poor because of a dearth of effective treatment options. However, the advent of chimeric antigen receptor (CAR) T-cell and T-cell redirecting bispecific antibody (BsAb) therapies has led to unprecedented response rates and durations of response in heavily relapsed/refractory (R/R) populations. Currently, two B-cell maturation antigen (BCMA)–directed CAR T-cell therapies (idecabtagene vicleucel and ciltacabtagene autoleucel) as well as one BCMA/CD3 BsAb (teclistamab) have been approved for late-line (greater than four previous lines) R/R MM in the United States. The purpose of this review is to analyze the recent data for these approved therapies as well as provide an overview of other related CAR T-cell and BsAb therapies under development, including non–BCMA-targeting agents. We review efficacy and safety considerations, with particular focus on cytokine release syndrome, neurotoxicity, and infection risk. The relative merits and limitations of each class of therapy are discussed, as well as the areas of unmet need with respect to optimal sequencing and supportive care measures. We examine the factors that challenge equitable access to these novel therapies across minoritized racial, ethnic, and socioeconomic populations. Although it is evident that CAR T-cell and BsAb therapies will transform treatment paradigms in MM for years to come, significant work remains to identify the optimal utilization of these novel therapies and ensure equitable access.

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Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials

Cited by 12 publications

References 66 publications

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

Chimeric Antigen Receptor T-Cell and Bispecific Antibody Therapy in Multiple Myeloma: Moving Into the Future

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