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Thibaud V, Billy C, Prud’homm J, Garin J, Hue B, Cattenoz C, Somme D, Corvol A. Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer. Cancers (Basel) 2022; 14:cancers14071642. [PMID: 35406414 PMCID: PMC8996864 DOI: 10.3390/cancers14071642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Comprehensive geriatric assessment is defined as a multi-dimensional, multi-disciplinary diagnostic and therapeutic process that is conducted to determine the medical, mental, and functional problems that older people with frailty have so that a coordinated and integrated plan for treatment and follow-up can be developed. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients. This review highlights the scarcity of published studies on this topic. Comprehensive geriatric assessment-based interventions have not yet demonstrated their specific impact. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. Abstract There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what “usual care” means will improve the external validity of such studies.
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Affiliation(s)
- Vincent Thibaud
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
- Department of Hematology, CHU Rennes, Université Rennes 1, 35000 Rennes, France
- Department of Hematology, Hôpital Saint-Vincent, Université Catholique de Lille, 59000 Lille, France
- Correspondence:
| | - Claire Billy
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
| | - Joaquim Prud’homm
- Laboratoire Traitement du Signal et de l’Image (INSERM LTSI—UMR 1099), CHU Rennes, Université Rennes 1, 35000 Rennes, France;
| | - Jeanne Garin
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
| | - Benoit Hue
- Department of Pharmacy, CHU Rennes, Université Rennes 1, 35000 Rennes, France;
| | - Catherine Cattenoz
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
- Centre Eugène Marquis, Department of Medical Oncology, Université Rennes 1, 35000 Rennes, France
| | - Dominique Somme
- Laboratoire Arènes(CNRS UMR 6051), CHU Rennes, Université Rennes 1, 35000 Rennes, France; (D.S.); (A.C.)
| | - Aline Corvol
- Laboratoire Arènes(CNRS UMR 6051), CHU Rennes, Université Rennes 1, 35000 Rennes, France; (D.S.); (A.C.)
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Couderc AL, Nouguerède E, Baumstarck K, Loubière S, Le Caer H, Guillem O, Rousseau F, Greillier L, Norguet-Monnereau E, Cecile M, Boulahssass R, Le Caer F, Tournier S, Butaud C, Guillet P, Nahon S, Kirscher S, Diaz N, Morando C, Villani P, Auquier P, Daumas A. PREDOMOS study, impact of a social intervention program for socially isolated elderly cancer patients: update to the study protocol for a randomized controlled trial. Trials 2019; 20:54. [PMID: 30646923 PMCID: PMC6334455 DOI: 10.1186/s13063-018-3127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Social isolation potentiates the risk of death by cancer in the older cancer patient population. The PREDOMOS study investigates the impact of establishing a Program of Social intervention associated with techniques of Domotic and Remote assistance on the improvement of quality of life of older isolated patients, treated for locally advanced or metastatic cancer. This paper updates the pilot trial protocol. Methods/design The original protocol was published in Trials, accessible at https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1894-7. This update reports on the eligibility criteria expansion and on the adjunction of a cost-utility analysis. We widened the eligible population to patients with locally advanced or metastatic cancer including malignant hemopathies (except acute myeloid leukemia) and to patients in the first and second lines of oncologic treatment. We restricted the inclusion to patients with a Mini Mental State Examination score strictly over 24. In addition to the secondary outcomes outlined in the protocol, a medico-economic analysis has been added to evaluate both the health benefits and costs of the two strategies and calculate the incremental cost-utility ratio of the innovative program assessed, compared to the standard practice. Trial registration ClinicalTrials.gov, NCT02829762. Registered on 29 June 2016.
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Affiliation(s)
- Anne-Laure Couderc
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France.,Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France
| | - Emilie Nouguerède
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France. .,Service d'Oncologie Digestive, CHU Timone, AP-HM, 264 Rue Saint Pierre, 13385, Marseille, cedex 05, France.
| | - Karine Baumstarck
- EA3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, cedex 05, France
| | - Sandrine Loubière
- EA3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, cedex 05, France
| | - Hervé Le Caer
- Service de Pneumologie, CH Yves le Foll, 10 rue Marcel Proust, Saint-Brieuc, France
| | - Olivier Guillem
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Onco-Gériatrie, CH Intercommunal des Alpes du Sud Site de Gap (CHICAS), 1 Place Auguste Muret, 05000, Gap, France
| | - Frédérique Rousseau
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Médicale, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite Dromel, 13009, Marseille, France
| | - Laurent Greillier
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Oncologie Multidisciplinaire et Innovation Thérapeutique, CHU NORD, AP-HM, Chemin des Bourrely, 13915, Marseille, cedex 20, France
| | - Emmanuelle Norguet-Monnereau
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Digestive, CHU Timone, AP-HM, 264 Rue Saint Pierre, 13385, Marseille, cedex 05, France
| | - Maud Cecile
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Médicale, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite Dromel, 13009, Marseille, France
| | - Rabia Boulahssass
- Service de Gérontologie, Hôpital de Cimiez, 4 Avenue Reine Victoria, CS 91179, 06003, Nice, France
| | - Françoise Le Caer
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service de Gériatrie, CH Yves le Foll, 10 rue Marcel Proust, Saint-Brieuc, France
| | - Sandrine Tournier
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service de Gériatrie, Hôpital Saint Joseph, 26 Boulevard Louvain, 13285, Marseille, cedex 08, France
| | - Chantal Butaud
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Unité Mobile de Gériatrie, Hôpital Saint Musse, CH Intercommunal Toulon-La Seyne sur Mer (CHITS), 54 Rue Henri Claire Deville, 83000, Toulon, France
| | - Pierre Guillet
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Unité Mobile de Gériatrie, Hôpital Saint Musse, CH Intercommunal Toulon-La Seyne sur Mer (CHITS), 54 Rue Henri Claire Deville, 83000, Toulon, France
| | - Sophie Nahon
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Hémato-Oncologie, CH du Pays d'Aix, Avenue les Tamaris, 13616, Aix-en-Provence, France
| | - Sylvie Kirscher
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Médicale, Institut Sainte Catherine (ISC), 250 Chemin de Baigne Pieds, 84918, Avignon, cedex 09, France
| | - Nadine Diaz
- Service Social, Hôpital Sainte Marguerite, AP-HM, 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France
| | - Claire Morando
- Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, 80 Rue Brochier, 13354, Marseille, cedex 05, France
| | - Patrick Villani
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France
| | - Pascal Auquier
- EA3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, cedex 05, France
| | - Aurélie Daumas
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France
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