|The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
When oncologists are provided a geriatric assessment (GA) report with recommended interventions, communication regarding functional status (FS) and physical performance (PP)-related concerns improved between older adults with advanced cancer and their oncologists. The findings were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
The investigators conducted a secondary analysis of data from a nationwide, multisite, cluster randomized controlled trial evaluating strategies to enhance communication between older persons with cancer and their caregivers (ClinicalTrials.gov Identifier: NCT02107443). Inclusion criteria for patients were age 70 and older, stage III/IV solid tumor or lymphoma with palliative treatment intent, and at least 1 GA domain impairment. All participants underwent baseline GA including standardized FS (activities of daily living scales) and PP (Timed Up and Go, Short Physical Performance Battery, Older Americans Resources and Services Physical Health scale, and report of falls in past 6 months) measures.
“While overall, patient-oncologist communication was improved in the primary analysis of this trial, domain-specific analyses were not conducted, and in general, despite their importance to cancer care, deficits in physical performance and functional status are both underassessed and undertreated,” said Marielle Jensen-Battaglia, DPT, of James P. Wilmot Cancer Institute, Rochester, New York.
In the intervention arm, oncologists received full GA results along with validated recommendations for each patient. In the usual care (control) arm, each patient’s oncologist was only notified when the patient presented with depression or severe cognitive impairment. Within 4 weeks of the GA, one clinical encounter per patient was audio-recorded and transcribed, and an a priori content analysis was used to categorize the conversations, patient concerns, and oncologists’ responses (dismissed, acknowledged, or addressed with recommendation) by GA domain (PS and PP concerns).
The study included 541 patients (mean age, 77 years; range, 70 to 96), 293 in the intervention arm and 248 in the control arm. Most patients were college educated (52%) and non-Hispanic White (89%). Significantly more FS and PP conversations occurred in the intervention arm than the control arm (PP, 532 vs 183; FS, 164 vs 87; P <.0001). In both arms, more than 90% of patients had impaired PP and approximately 59% had impaired FS. Following statistical adjustment for study site, the proportion of all patients having one or more FS or PP conversation initiated by their oncologist was higher in the intervention arm than the control arm (85.8% vs 58.6%; P <.0001). Oncologists in the intervention arm were more likely to address FS and PP concerns (42.58% vs 16.52%; P =.0003) and to use referrals (23.52% vs 5.0%; P <.0001) or information/written materials (22.31% vs 3.83%; P =.0006) to address them than oncologists in the control arm.
“Our analysis offers strong evidence that a geriatric assessment intervention leads to an increase in oncologist-initiated conversations regarding functional status and physical performance aging-related concerns,” concluded Dr Jensen-Battaglia.
Disclosure: This research was supported by the US National Institutes of Health. Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Read more of Oncology Nurse Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.
Jensen-Battaglia M, Lei L, Xu H, et al. The effects of geriatric assessment on oncologist-patient communication regarding functional status and physical performance in older adults with cancer: A secondary analysis of a 541-subject nationwide URCC NCORP (NCI Community Oncology Research Program) cluster randomized trial. J Clin Oncol. 2021;39(suppl 15; abstr 12010). doi: 10.1200/JCO.2021.39.15_suppl.12010