Including a geriatric assessment (GA) in oncology clinical visits for elderly patients with advanced cancer improved patient- and caregiver-centered communication regarding concerns about aging, according to results from the cluster-randomized Improving Communication in Older Cancer Patients and Their Caregivers (COACH) clinical trial (ClinicalTrials.gov identifier: NCT02107443) published in JAMA Oncology.
Older patients with cancer and their caregivers often are concerned about the effects of treatment toxicity on areas related to aging, such as cognition and function. A GA can assess evidence-based conditions of aging correlated with inferior clinical outcomes for elderly patients.
In the COACH trial, researchers evaluated whether providing a GA summary and GA-guided recommendations to clinicians could improve communication with patients and caregivers about aging-related concerns. They enrolled 541 patients aged 70 years or older with an advanced solid malignant tumor or lymphoma and at least 1 impaired GA domain and 414 caregivers.
A total of 31 community oncology practices participated and were randomized to receive either a customized GA summary with GA-guided recommendations specific to each patient or to only receive alerts for patients meeting criteria for cognitive impairment or depression as part of usual care.
Patients in the intervention arm were more satisfied following visits with communication about concerns related to aging, with a difference in mean score from the usual care arm of 1.09 points (95% confidence interval [CI], 0.05-2.13; P =.04). This improvement in satisfaction following such visits persisted at 6 months of follow-up, with a difference in mean score from the usual care arm of 1.10 (95% CI, 0.04-2.16; P =.04). More aging-related conversations occurred in appointments in the intervention group (difference, 3.59; 95% CI, 2.22-4.95; P <.001).
Furthermore, caregivers of patients in the intervention arm were more satisfied with communication after appointments than in the usual care arm, with a difference of 1.05 (95% CI, 0.12-1.98; P =.03).
In spite of these differences in satisfaction, quality of life outcomes did not differ between the 2 groups, though this was a secondary rather than primary end point.
“COACH demonstrated that a practical and convenient GA summary with recommendations for aging-sensitive interventions improves patient-centered outcomes and thus should be considered as the standard of care for older patients with cancer,” concluded the authors.
Mohile SG, Epstein RM, Hurria A, et al. Communication with older patients with cancer using geriatric assessment: a cluster-randomized clinical trial from the National Cancer Institute Community Oncology Research Program [published online November 7, 2019]. JAMA Oncol. doi: 10.1001/jamaoncol.2019.4728