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Slaaen M, Røyset IM, Saltvedt I, Grønberg BH, Halsteinli V, Døhl Ø, Vossius C, Kirkevold Ø, Bergh S, Rostoft S, Oldervoll L, Bye A, Melby L, Røsstad T, Eriksen GF, Sollid MIV, Rolfson D, Šaltytė Benth J. Geriatric assessment with management for older patients with cancer receiving radiotherapy: a cluster-randomised controlled pilot study. BMC Med 2024; 22:232. [PMID: 38853251 PMCID: PMC11163782 DOI: 10.1186/s12916-024-03446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/24/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Geriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting. METHODS In this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients' care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137. RESULTS We included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0-17], scores 0-3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period. CONCLUSIONS In this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.
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Affiliation(s)
- Marit Slaaen
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, Oslo, 0318, Norway
| | - Inga Marie Røyset
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway.
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway.
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway.
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway
| | - Bjørn Henning Grønberg
- Department of Oncology, St. Olav Hospital, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Vidar Halsteinli
- Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway
| | - Øystein Døhl
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway
- Trondheim Municipality, Trondheim Kommune, Postboks , Trondheim, Norway
| | - Corinna Vossius
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Kirkevold
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Postboks , Tønsberg, 2136, 3103, Norway
- Department of Health Sciences in Gjøvik, NTNU, Box 191, N-2802, Gjøvik, Norway
| | - Sverre Bergh
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Postboks , Tønsberg, 2136, 3103, Norway
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, Oslo, 0318, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Pb , Nydalen, Norway
| | - Line Oldervoll
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, 7807, 5020, Bergen, PB, Norway
- Department of Public Health and Nursing, NTNU, 8905, 7491, Trondheim, PB, Norway
| | - Asta Bye
- Oslo Metropolitan University (Oslomet), Postboks 4, St. Olavs Plass, 0130, Oslo, Norway
- European Palliative Care Research Centre (PRC), Institute of Clinical Medicine, Faculty of Medicine, Department of Oncology, University of Oslo, and, Oslo University Hospital, Nydalen, Norway
| | - Line Melby
- Department of Health Sciences in Gjøvik, NTNU, Box 191, N-2802, Gjøvik, Norway
| | - Tove Røsstad
- Trondheim Municipality, Trondheim Kommune, Postboks , Trondheim, Norway
- Department of Public Health and Nursing, NTNU, 8905, 7491, Trondheim, PB, Norway
| | - Guro Falk Eriksen
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, Oslo, 0318, Norway
- Department of Internal Medicine, Hamar Hospital, Innlandet Hospital Trust, Skolegata 32, 2318, Hamar, Norway
| | - May Ingvild Volungholen Sollid
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Department of Health Sciences in Gjøvik, NTNU, Box 191, N-2802, Gjøvik, Norway
| | - Darryl Rolfson
- Division of Geriatric Medicine, Clinical Sciences Building, University of Alberta, 1-19811350 83 Ave, Edmonton, AB, T6G 2P4, Canada
| | - Jūratė Šaltytė Benth
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, P.O.Box 1171, 0318, Blindern, Norway
- Health Services Research Unit, Akershus University Hospital, P.O.Box 1000, 1478, Lørenskog, Norway
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Volungholen Sollid MI, Slaaen M, Danielsen S, Eilertsen G, Kirkevold Ø. Patient-Reported Experiences and Associated Factors in a Norwegian Radiotherapy Setting: An Explorative Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241233868. [PMID: 38406180 PMCID: PMC10893778 DOI: 10.1177/23779608241233868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care.
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Affiliation(s)
- May Ingvild Volungholen Sollid
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Faculty of Medicine and Health Sciences, Gjøvik, Norway
| | - Marit Slaaen
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Signe Danielsen
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen G, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen G, Norway
| | - Øyvind Kirkevold
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Faculty of Medicine and Health Sciences, Gjøvik, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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