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

Dale, William; Klepin, Heidi D.; Williams, Grant R.; Alibhai, Shabbir M.H.; Bergerot, Cristiane Decat; BrintzenhofeSzoc, Karlynn; Hopkins, Judith O.; Jhawer, Minaxi; Katheria, Vani; Loh, Kah Poh; Lowenstein, Lisa M.; McKoy, June M.; Noronha, Vanita; Phillips, Tanyanika; Rosko, Ashley; Ruegg, Tracy A.; Schiaffino, Melody K.; Simmons, John F.; Subbiah, Ishwaria Mohan; Tew, William P.; Webb, Tracy; Whitehead, Mary; Somerfield, Mark R.; Ligibel, Jennifer A

doi:10.1200/jco.23.00933

Cited by 109 publications

(55 citation statements)

References 85 publications

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“…A CGA is a multidimensional process to identify medical, social, and functional needs and is associated with chemotherapy-related toxic effects, functional decline, and mortality . By performing a pretreatment CGA, physicians may facilitate nononcologic interventions or individualize treatment plans, thereby likely reducing the risk of toxic effects and possibly improving QOL . Previous trials showed that a GA-based intervention could reduce chemotherapy-related toxic effects and early treatment discontinuation compared with usual care …”

Section: Discussionmentioning

confidence: 99%

Chemotherapy-Related Toxic Effects and Quality of Life and Physical Functioning in Older Patients

Baltussen,

de Glas,

van Holstein

et al. 2023

JAMA Netw Open

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ImportanceAlthough older patients are at increased risk of developing grade 3 or higher chemotherapy-related toxic effects, no studies, to our knowledge, have focused on the association between toxic effects and quality of life (QOL) and physical functioning.ObjectiveTo investigate the association between grade 3 or higher chemotherapy-related toxic effects and QOL and physical functioning over time in older patients.Design, Setting, and ParticipantsIn this prospective, multicenter cohort study, patients aged 70 years or older who were scheduled to receive chemotherapy with curative or palliative intent and a geriatric assessment were included. Patients were treated with chemotherapy between December 2015 and December 2021. Quality of life and physical functioning were analyzed at baseline and after 6 months and 12 months.ExposuresCommon Terminology Criteria for Adverse Events grade 3 or higher chemotherapy-related toxic effects.Main Outcomes and MeasuresThe main outcome was a composite end point, defined as a decline in QOL and/or physical functioning or mortality at 6 months and 12 months after chemotherapy initiation. Associations between toxic effects and the composite end point were analyzed with multivariable logistic regression models.ResultsOf the 276 patients, the median age was 74 years (IQR, 72-77 years), 177 (64%) were male, 196 (71%) received chemotherapy with curative intent, and 157 (57%) had gastrointestinal cancers. Among the total patients, 145 (53%) had deficits in 2 or more of the 4 domains of the geriatric assessment and were classified as frail. Grade 3 or higher toxic effects were observed in 94 patients (65%) with frailty and 66 (50%) of those without frailty (P = .01). Decline in QOL and/or physical functioning or death was observed in 76% of patients with frailty and in 64% to 68% of those without frailty. Among patients with frailty, grade 3 or higher toxic effects were associated with the composite end point at 6 months (odds ratio [OR], 2.62; 95% CI, 1.14-6.05) but not at 12 months (OR, 1.09; 95% CI, 0.45-2.64) and were associated with mortality at 12 months (OR, 3.54; 95% CI, 1.50-8.33). Toxic effects were not associated with the composite end point in patients without frailty (6 months: OR, 0.76; 95% CI, 0.36-1.64; 12 months: OR, 1.06; 95% CI, 0.46-2.43).Conclusions and RelevanceIn this prospective cohort study of 276 patients aged 70 or older who were treated with chemotherapy, patients with frailty had more grade 3 or higher toxic effects than those without frailty, and the occurrence of toxic effects was associated with a decline in QOL and/or physical functioning or mortality after 1 year. Toxic effects were not associated with poor outcomes in patients without frailty. Pretreatment frailty screening and individualized treatment adaptions could prevent a treatment-related decline of remaining health.

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Section: Discussionmentioning

confidence: 99%

Chemotherapy-Related Toxic Effects and Quality of Life and Physical Functioning in Older Patients

Baltussen,

de Glas,

van Holstein

et al. 2023

JAMA Netw Open

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“…Cognitive assessment as part of age-friendly healthcare aligns with the holistic assessment of older adults with cancer. The recently updated ASCO guidelines for older adults with cancer include recommendations for a practical geriatric assessment (GA) [26]. Recommendation 2.1 'A GA should include high priority ageing-related domains known to be associated with outcomes in Adapted from [13].…”

Section: Mentationmentioning

confidence: 99%

“…older adults with cancer to include assessment of physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support' [26,27]. Screening for cognitive impairment, delirium and depression, depending on the healthcare setting is a vital part of adequate GA and implementation of AFHS [20,28].…”

Section: Mentationmentioning

confidence: 99%

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Age-friendly healthcare: integrating the 4Ms to enable age-friendly cancer care

Hodge,

Rasekaba,

Blackberry

et al. 2024

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review There is a growing movement towards person-centred, age-friendly healthcare in the care of older adults, including those with cancer. The Age-Friendly Health Systems (AFHS) initiative uses the 4Ms framework to enable this change. This review documents the utility and implications of 4Ms implementation across different settings, with a particular focus on cancer care. Recent findings The AFHS initiative 4Ms framework uses a set of core, evidence-based guidelines (focussing on What Matters, Medication, Mentation and Mobility) to improve person-centred care. The successful implementation of the 4Ms has been documented in many different healthcare settings including orthopaedics primary care, and cancer care. Implementation of the 4Ms framework into existing workflows complements the use of geriatric assessment to improve care of older adults with cancer. Models for implementation of the 4Ms within a cancer centre are described. Active engagement and education of healthcare providers is integral to success. Solutions to implementing the What Matters component are addressed. Summary Cancer centres can successfully implement the 4Ms framework into existing workflows through a complex change management process and development of infrastructure that engages healthcare providers, facilitating cultural change whilst employing quality improvement methodology to gradually adapt the status quo to age-friendly processes.

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“…Figure 1 presents the summary of the updated guideline recommendations addressed in this article; the complete recommendations appear in the full guideline update (cite new GA guideline). 5…”

Section: Question 1: What Are the Changes To The Updated Ga Guideline?mentioning

confidence: 99%

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

Williams

Hopkins

Klepin

et al. 2023

JCO Oncology Practice

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

Cited by 109 publications

References 85 publications

Chemotherapy-Related Toxic Effects and Quality of Life and Physical Functioning in Older Patients

Chemotherapy-Related Toxic Effects and Quality of Life and Physical Functioning in Older Patients

Age-friendly healthcare: integrating the 4Ms to enable age-friendly cancer care

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

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