The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO)

Abstract

Background Older patients with colorectal cancer (CRC) experience chemotherapy dose reductions or discontinuation. Comprehensive geriatric assessment (CGA) predicts survival and chemotherapy completion in patients with cancer, but the benefit of geriatric interventions remains unexplored. Methods The GERICO study is a randomised Phase 3 trial including patients ≥70 years receiving adjuvant or first-line palliative chemotherapy for CRC. Vulnerable patients (G8 questionnaire ≤14 points) were randomised 1:1 to CGA-based interventions or standard care, along with guideline-based chemotherapy. The primary outcome was chemotherapy completion without dose reductions or delays. Secondary outcomes were toxicity, survival and quality of life (QoL). Results Of 142 patients, 58% received adjuvant and 42% received first-line palliative chemotherapy. Interventions included medication changes (62%), nutritional therapy (51%) and physiotherapy (39%). More interventional patients completed scheduled chemotherapy compared with controls (45% vs. 28%, P = 0.0366). Severe toxicity occurred in 39% of controls and 28% of interventional patients (P = 0.156). QoL improved in interventional patients compared with controls with the decreased burden of illness (P = 0.048) and improved mobility (P = 0.008). Conclusion Geriatric interventions compared with standard care increased the number of older, vulnerable patients with CRC completing adjuvant chemotherapy, and may improve the burden of illness and mobility. Trial registration ClinicalTrials.gov ID: NCT 02748811.

Predictive value of geriatric oncology screening and geriatric assessment of older patients with cancer: A randomized clinical trial protocol (PROGNOSIS-RCT)

“…Currently, few RCT studies have examined the effects of CGA in older patients with various cancer sites receiving antineoplastic treatment. Only one of these studies specifically screened for frailty using the G8, though exclusively included patients with colorectal cancer stage II-IV [27]. This study showed a positive effect of receiving CGA on chemotherapy treatment completion.…”

“…The G8 is based on the Mini Nutritional Assessment, with scores ranging from 0 to 17 and a cut-off for frailty at G8 ≤ 14 [24]. The G8 has previously been applied in several Danish studies, with percentages of G8 frailty in older patients with cancer ranging from 50 to 72% [25][26][27][28][29].…”

“…Until recently, research has primarily examined CGA as a means to guide oncologic treatment, as opposed to viewing CGA as an additional intervention, thus evidence is sparse [31]. The GERICO study, a randomized control trial (RCT) examining older patients with colorectal cancer receiving either adjuvant or first line palliative chemotherapy, and screened as frail with the G8, recently found that CGA with corresponding interventions reduced chemotherapy toxicity, increased chemotherapy treatment completion and increased physical functioning [27]. Preliminary results from two ongoing RCTs with mixed cancer populations support the chemotherapy toxicity findings [32,33].…”

Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies

“…Our trial addresses a critical gap regarding the effectiveness of geriatrics-driven interventions in older patients with hematologic malignancies, complementing emerging evidence from other studies predominantly consisting of older adults with solid tumors. [15][16][17][27][28][29][30][31] Few prior studies have investigated GA-driven interventions for patients with blood cancers. Artz and colleagues recently reported that in patients with a median age of 67 undergoing hematopoietic stem cell transplantation for blood cancers, GA-driven interventions implemented by a multidisciplinary geriatrics team improved 1-year overall survival in comparison with conducting a GA alone without a multidisciplinary team to manage any detected vulnerabilities.…”

Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

“…GA has been demonstrated to alter the initial oncology treatment plan in at least a quarter of patients (median 28%; range 8-54%), with non-oncological interventions being recommended in almost three-quarters of patients (median 72%; range 26-100%) [15]. Recent randomized controlled trials demonstrated improvements in quality of life, unplanned hospital admissions, and reduced chemotherapy toxicity and early treatment discontinuation, confirming the importance of GA in older cancer patients [16][17][18][19]. In addition, several Oncological Societies internationally have published guidelines on GA, which include recommendations for cognitive assessment or screening [1,[20][21][22].…”