A randomized controlled trial evaluated the use of geriatric consultations in patients with hematologic malignancies, with results suggesting that such consultations did not impact overall survival (OS), but were useful in other aspects of care. Findings of this study were reported in the journal Haematologica.
“Compared with younger patients, older patients with blood cancers often have age-related vulnerabilities that complicate their care,” the study investigators explained in their report. The American Society of Clinical Oncology (ASCO) also recommends geriatric assessments for older patients with cancer being treated with chemotherapy. Research on the impacts of geriatric assessments in patients with hematologic malignancies has been limited, they explained, so they aimed to evaluate the impacts of such consultations in this patient population.
In this trial (ClinicalTrials.gov Identifier: NCT02359838), transplant-ineligible patients with hematologic malignancies who were aged 75 years and older and in frail or prefrail condition were randomly assigned across 2 trial arms. One trial arm received standard oncologic care; the other arm received standard oncologic care plus consultation with a geriatrician.
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One-year OS after the time of initial hematology-oncology consultation was the primary study outcome. Secondary outcomes were analyzed based on chart reviews and involved end-of-life (EOL) goals-of-care discussions and unplanned care utilization during a 6-month follow-up period. Hematology-oncology clinicians also were surveyed regarding perceptions of their patients’ consultations.
The overall patient population was median age 80.4 years (SD, 4.2). The standard-care arm consisted of 100 patients. The standard care plus consultation arm consisted of 60 patients, 48 (80%) of whom completed at least 1 geriatric consultation. Of those patients, 26 completed additional geriatric consultations.
One-year OS was not significantly better with consultations (81.7%) than without (78.8%), showing a difference of 2.9% (95% CI, −9.5% to 15.2%; P =.65). Additionally, emergency department visits, hospitalizations, and lengths of stay were similar between groups.
However, patients in the consultation arm were significantly more likely to have documented EOL goals-of-care discussions (odds ratio, 3.12; 95% CI, 1.03-9.41). Hematology-oncology clinicians also mostly perceived geriatric consultations as being useful for management of a variety of geriatric domains, at rates of 62.9% to 88.2%, depending on the domain.
The study investigators concluded that the geriatric consultations in this trial did not improve survival or healthcare utilization for this population of patients, but they were useful for EOL goals-of-care discussions and were perceived by clinicians to be valuable.
“Lessons learned from our trial complemented by the results emerging from others suggest that ensuring earlier delivery and more longitudinal co-management may be necessary to have an impact on outcomes such as survival and hospitalizations,” the investigators concluded.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
DuMontier C, Uno H, Hshieh T, et al. Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies. Haematologica. 2022;107(5):1172-1180. doi:10.3324/haematol.2021.278802
