Using Geriatric Assessment to Guide Conversations Regarding Comorbidities Among Older Patients With Advanced Cancer

Abstract

PURPOSE: Older patients with advanced cancer often have comorbidities that can worsen their cancer and treatment outcomes. We assessed how a geriatric assessment (GA)–guided intervention can guide conversations about comorbidities among patients, oncologists, and caregivers. METHODS: This secondary analysis arose from a nationwide, multisite cluster-randomized trial (ClinicalTrials.gov identifier: NCT02107443 ). Eligible patients were ≥ 70 years, had advanced cancer (solid tumors or lymphoma), and had impairment in at least one GA domain (not including polypharmacy). Oncology practices (n = 30) were randomly assigned to usual care or intervention. All patients completed a GA; in the intervention arm, a GA summary with recommendations was provided to their oncologist. Patients completed an Older Americans Resources and Services Comorbidity questionnaire at screening. The clinical encounter following GA was audio-recorded, transcribed, and coded for topics related to comorbidities. Linear mixed models examined the effect of the intervention on the outcomes adjusting for practice site as a random effect. RESULTS: Patients (N = 541) were 76.6 ± 5.2 years old; 94.6% of patients had at least one comorbidity with an average of 3.2 ± 1.9. The intervention increased the average number of conversations regarding comorbidities per patient from 0.52 to 0.99 ( P < .01). Moreover, there were a greater number of concerns acknowledged (0.52 v 0.32; P = .03) and there was a 2.4-times higher odds of having comorbidity concerns addressed via referral, handout, or other modes (95% CI, 1.3 to 4.3; P = .004). Most oncologists in the intervention arm (76%) discussed comorbidities in light of the treatment plan, and 41% tailored treatment plans. CONCLUSION: Providing oncologists with a GA-guided intervention enhanced communication regarding comorbidities.

Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults

“…This intervention has previously been shown to be associated with an increase in conversations about comorbidity . In a subset of participants, the intervention and usual care groups discussed polypharmacy with similar frequency; however, oncologists initiated conversations about polypharmacy more frequently in the intervention group, echoing our finding in functional status and physical performance domains.…”

“…32,39 This intervention has previously been shown to be associated with an increase in conversations about comorbidity. 53 In a subset of participants, the intervention and usual care groups discussed polypharmacy with similar frequency 54 ; however, oncologists initiated conversations about polypharmacy more frequently in the intervention group, echoing our finding in functional status and physical performance domains. In this secondary analysis, a similar number of patients and caregivers in the intervention group voiced their concerns in each group, which may reflect the importance of these domains to patients.…”

Prescription of Potentially Inappropriate Medication Use in Older Cancer Outpatients With Multimorbidity: Concordance Among the Chinese, AGS/Beers, and STOPP Criteria

“…China is currently the country with the largest older cancer population in the world, and cancer as a chronic disease places a heavy burden on the elderly. Older cancer patients can suffer from a higher rate of comorbidity, frailty, and geriatric syndrome, putting them at a high risk of polypharmacy and PIM use ( Pamoukdjian et al, 2020 ; Kleckner et al, 2022 ). To the best of our knowledge, this is the first cross-sectional study on the prevalence and risk factors for PIM use in Chinese older cancer outpatients according to the three criteria.…”

Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors

“…Tools such as those included in geriatric assessment could be an ideal provider-level intervention to guide comorbidity management in older cancer survivors and potentially improve medication adherence, improve health, and decrease costs. [44][45][46] The 2018 American Society of Clinical Oncology guidelines recommend geriatric assessments for adults age $ 65 years with a history of cancer. 47 However, only half of cancer providers are aware of this guideline, with less than half using the comorbidity-specific tool with their patients.…”