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Puts M, Waked JAA, Strohschein F, Breunis H, Alqurini N, Berger A, Romanovsky L, Monette J, Mehta R, Li A, Wan-Chow-Wah D, Koneru R, Szumacher E, Mariano C, Hsu T, Brennenstuhl S, Amir E, Krzyzanowska MK, Jang R, Pitters E, Emmenegger U, Menjak IB, Bergman S, Lemonde M, Beland F, Alibhai SMH. Implementing geriatric assessment and management for older Canadians with cancer: Adherence to and satisfaction with the intervention, results of the 5C study. J Geriatr Oncol 2023; 14:101586. [PMID: 37459767 DOI: 10.1016/j.jgo.2023.101586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Geriatric assessment and management (GAM) is recommended by professional organizations and recently several randomized controlled trials (RCTs) demonstrated benefits in multiple health outcomes. GAM typically leads to one or more recommendations for the older adult on how to optimize their health. However, little is known about how well recommendations are adhered to. Understanding these issues is vital to designing GAM trials and clinical programs. Therefore, the aim of this study was to examine the number of GAM recommendations made and adherence to and satisfaction with the intervention in a multicentre RCT of GAM for older adults with cancer. MATERIALS AND METHODS The 5C study was a two-group parallel RCT conducted in eight hospitals across Canada. Each centre kept a detailed recruitment and retention log. The intervention teams documented adherence to their recommendations. Medical records were also reviewed to assess which recommendations were adhered to. Twenty-three semi-structured interviews were conducted with 12 members of the intervention teams and 11 oncology team members to assess implementation of the study and the intervention. RESULTS Of the 350 participants who were enrolled, 173 were randomized to the intervention arm. Median number of recommendations was seven. Mean adherence to recommendations based on the GAM was 69%, but it varied by type of recommendation, ranging from 98% for laboratory tests to 28% for psychosocial/psychiatry oncology referrals. There was no difference in the number of recommendations or non-adherence to recommendations by sex, level of frailty, or functional status. Oncologists and intervention team members were satisfied with the study implementation and intervention delivery. DISCUSSION Adherence to recommendations was variable. Adherence to laboratory investigations and further imaging were generally high but much lower for recommendations regarding psychosocial support. Further collaborative work with older adults with cancer is needed to understand how to optimize the intervention to be consistent with patient goals, priorities, and values to ensure maximal impact on health outcomes.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Jihad Abou Ali Waked
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Fay Strohschein
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Henriette Breunis
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Naser Alqurini
- Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Arielle Berger
- Department of Geriatric Medicine, University Health Network, Ontario, Canada
| | - Lindy Romanovsky
- Department of Geriatric Medicine, University Health Network, Ontario, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anson Li
- Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Doreen Wan-Chow-Wah
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Caroline Mariano
- Department of Medical Oncology, BC Cancer center, Vancouver, British Columbia, Canada
| | - Tina Hsu
- Division of Medical Oncology, the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eric Pitters
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ines B Menjak
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simon Bergman
- Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Francois Beland
- Public Health School, University of Montreal, Montreal, Quebec, Canada
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Puts M, Alqurini N, Strohschein F, Koneru R, Szumacher E, Mariano C, Monette J, Hsu T, Brennenstuhl S, McLean B, Wills A, Berger A, Amir E, Romanovsky L, Li A, Mehta R, Krzyzanowska M, Elser C, Jang R, Prica A, Wan-Chow-Wah D, Pitters E, Emmenegger U, Menjak IB, Bergman S, Lemonde M, Breunis H, Béland F, Alibhai SM. Impact of Geriatric Assessment and Management on Quality of Life, Unplanned Hospitalizations, Toxicity, and Survival for Older Adults With Cancer: The Randomized 5C Trial. J Clin Oncol 2023; 41:847-858. [PMID: 36473126 PMCID: PMC9902020 DOI: 10.1200/jco.22.01007] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE American Society of Clinical Oncology recommends that older adults with cancer being considered for chemotherapy receive geriatric assessment (GA) and management (GAM), but few randomized controlled trials have examined its impact on quality of life (QOL). PATIENTS AND METHODS The 5C study was a two-group parallel 1:1 single-blind multicenter randomized controlled trial of GAM for 6 months versus usual oncologic care. Eligible patients were age 70+ years, diagnosed with a solid tumor, lymphoma, or myeloma, referred for first-/second-line chemotherapy or immunotherapy or targeted therapy, and had an Eastern Cooperative Oncology Group performance status of 0-2. The primary outcome QOL was measured with the global health scale of the European Organisation for the Research and Treatment of Cancer QOL questionnaire and analyzed with a pattern mixture model using an intent-to-treat approach (at 6 and 12 months). Secondary outcomes included functional status, grade 3-5 treatment toxicity; health care use; satisfaction; cancer treatment plan modification; and overall survival. RESULTS From March 2018 to March 2020, 350 participants were enrolled. Mean age was 76 years and 40.3% were female. Fifty-four percent started treatment with palliative intent. Eighty-one (23.1%) patients died. GAM did not improve QOL (global QOL of 4.4 points [95% CI, 0.9 to 8.0] favoring the control arm). There was also no difference in survival, change in treatment plan, unplanned hospitalization/emergency department visits, and treatment toxicity between groups. CONCLUSION GAM did not improve QOL. Most intervention group participants received GA on or after treatment initiation per patient request. Considering recent completed trials, GA may have benefit if completed before treatment selection. The COVID-19 pandemic may have affected our QOL outcome and intervention delivery for some participants.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,Martine Puts, RN, PhD, FAAN, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Suite 130, Toronto, ON, Canada M5T 1P8; e-mail:
| | - Naser Alqurini
- Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Fay Strohschein
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Caroline Mariano
- Department of Medical Oncology, BC Cancer Center, Vancouver, British Columbia, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Bianca McLean
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Arielle Berger
- Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Lindy Romanovsky
- Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada
| | - Anson Li
- Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Christine Elser
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Doreen Wan-Chow-Wah
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Eric Pitters
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ines B. Menjak
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simon Bergman
- Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Francois Béland
- Public Health School, University of Montreal, Montreal, Quebec, Canada
| | - Shabbir M.H. Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Pitters E, Puts M, Alqurini N, Strohschein F, Koneru R, Szumacher E, Mariano C, Monette J, Hsu T, Brennenstuhl S, McLean B, Wills A, Berger A, Amir E, Romanovsky L, Li A, Mehta R, Krzyzanowska M, Elser C, Jang R, Prica A, Wan-Chow-Wah D, Emmenegger U, Menjak I, Bergman S, Lemonde M, Krahn M, Beland F, Breunis H, Alibhai S. The impact of the COVID-19 pandemic on quality of life, health care use and mortality in older adults in the 5C study of geriatric assessment and management: secondary analysis. J Geriatr Oncol 2022. [PMCID: PMC9595410 DOI: 10.1016/s1879-4068(22)00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Puts M, Alqurini N, Strohschein F, Berger A, Romanovsky L, Monette J, Mehta R, Li A, Wan-Chow-Wah D, Hsu T, Brennenstuhl S, Koneru R, Szumacher E, Mariano C, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Jang R, Prica A, Pitters E, Emmenegger U, Menjak I, Bergman S, Lemonde M, Breunis H, Beland F, Krahn M, Alibhai S. Recommendations and adherence to recommendations made based on a comprehensive geriatric assessment for Canadian older adults with cancer: Results of the 5C trial. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pilleron S, Alqurini N, Ferlay J, Haase KR, Hannan M, Janssen-Heijnen M, Kantilal K, Katanoda K, Kenis C, Lu-Yao G, Matsuda T, Navarrete E, Nikita N, Puts M, Strohschein FJ, Morris EJA. International trends in cancer incidence in middle-aged and older adults in 44 countries. J Geriatr Oncol 2022; 13:346-355. [PMID: 34866023 DOI: 10.1016/j.jgo.2021.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/24/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We examine international incidence trends of lung, colorectal, prostate, and breast cancers, as well as all cancers combined excluding non-melanoma skin cancer (NMSC) in adults aged 50 and older, over a fifteen-year period using data from 113 high quality population-based cancer registries included in the Cancer in Five Continents (CI5) series and NORDCAN. MATERIALS AND METHODS We calculated annual incidence rates between 1998 and 2012 for ages 50-64, 65-74, and 75+, by sex and both sexes combined. We estimated average annual percentage change (AAPC) in rates using quasi-Poisson regression models. RESULTS From 1998 to 2012, incidence trends for all cancers (excluding NMSC) have increased in most countries across all age groups, with the greatest increase observed in adults aged 75+ in Ecuador (AAPC = +3%). Colorectal cancer incidence rates increased in the majority of countries, across all age groups. Lung cancer rates among females have increased but decreased for males. Prostate cancer rates have sharply increased in men aged 50-64 with AAPC between 5% and 15% in 24 countries, while decreasing in the 75+ age group in 21 countries, by up to -7% in Bahrain. Female breast cancer rates have increased across all age groups in most countries, especially in the 65-74 age group and in Asia with AAPC increasing to 7% in the Republic of Korea. CONCLUSIONS These findings assist with anticipating changing patterns and needs internationally. Due to the specific needs of older patients, it is urgent that cancer systems adapt to address their growing number.
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Affiliation(s)
- Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK.
| | - Naser Alqurini
- Central Department of Primary Health Care, Geriatric Unit- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | - Michelle Hannan
- Department of Medical Oncology, University Hospital Waterford, Ireland.
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | - Kumud Kantilal
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Japan.
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Grace Lu-Yao
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Division of International Collaborative Research, Center for Public Health Sciences, National Cancer Center, Japan.
| | - Tomohiro Matsuda
- Division of International Collaborative Research, Center for Public Health Sciences, National Cancer Center, Japan.
| | - Erna Navarrete
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Chile.
| | - Nikita Nikita
- Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, PA, USA
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto. Canada.
| | | | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
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Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
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Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Puts M, Alqurini N, Strohschein F, Mariano C, Monette J, Wan-Chow-Wah D, Szumacher E, Koneru R, Mehta R, Li A, Hsu T, Brennenstuhl S, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Pitters E, Breunis H, Berger A, Romanovsky L, Alibhai S. Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Puts M, Alqurini N, Strohschein F, Monette J, Wan-Chow-Wah D, Koneru R, Szumacher E, Mehta R, Mariano CJ, Li A, Hsu T, Brennenstuhl S, Mclean B, Wills A, Amir E, Krzyzanowska MK, Elser C, Pitters E, Breunis H, Alibhai SM. Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12011 Background: Comprehensive Geriatric Assessment (CGA) is recommended by ASCO for older adults with cancer undergoing chemotherapy to identify issues that can interfere with treatment delivery and optimize functional status and quality of life. However, few randomized controlled trials have been completed so far. Our objective is to evaluate the effectiveness of CGA on improving quality of life for older adults receiving cancer treatment. Methods: Eligible patients were aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, speaking English/French, and with an Eastern Collaborative Oncology Group Performance Status 0–2. The CGA was done by a nurse and geriatrician followed by monthly phone calls by the study nurse for 6 months. Patients were randomly assigned (1:1) to receive either the intervention (CGA plus follow-up by geriatric trained team in addition to usual oncology care) or usual care alone. All participants received a monthly healthy aging booklet for attention control. Randomization was stratified by center and treatment intent (curative/adjuvant versus palliative). Our primary outcome was health-related quality of life (HRQOL) assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health scale (items 29 and 30). Secondary outcomes include functional status (Instrumental Activities of Daily Living). Outcome data collection was completed monthly for the first 6 months, then at 9 and 12 months. For the primary outcome we used a pattern mixture model using an intent-to-treat approach (at 0, 3, and 6 months). The last data collection took place March 8 2021. Results: From May 2017 to March 2020, 351 participants from 8 hospitals across Canada were enrolled. All patients were seen on or after day 1 of treatment for the intervention per patient request. Patient characteristics at baseline were similar in both arms. The average age was 75.7 (SD = 4.8), 60.4% was male and 54.3% had treatment with palliative intent. Change in HRQOL scores did not differ by arm (p =.80). Neither group exceeded the MCID of 10 points. There was also no difference in IADL between the groups (p = 0.82). Conclusion: CGA was not effective in improving quality of life for older adults receiving cancer treatment in this study. CGA may need to be performed prior to treatment initiation to achieve benefits. Clinical trial information: NCT03154671.
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Affiliation(s)
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | | | - Johanne Monette
- McGill University, Jewish General Hospital, Montréal, QC, Canada
| | | | | | - Ewa Szumacher
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rajin Mehta
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Anson Li
- Royal Columbian Hospital, New Westminster, BC, Canada
| | - Tina Hsu
- Ottawa Hospital, Ottawa, ON, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Bianca Mclean
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, Toronto, ON, Canada
| | - Eitan Amir
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Christine Elser
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Puts M, Strohschein F, Mclean B, Alqurini N, Syed A, Amir E, Béland F, Berger A, Bergman S, Vanderbyl B, Breunis H, Elser C, Emmenegger U, Fung S, Hsu T, Jang R, Krahn M, Koneru R, Kozlowski N, Krzyzanowska M, Lemonde M, Li A, Mariano C, Mehta R, Monette J, Papadakos J, Pitters E, Prica A, Ray J, Romanofsky L, Szumacher E, Wan-Chow-Wah D, Langleben A, Alibhai S. CLINICAL AND COST-EFFECTIVENESS OF COMPREHENSIVE GERIATRIC ASSESSMENT AND MANAGEMENT FOR CANADIAN ELDERS WITH CANCER: THE 5C STUDY – INITIAL RECRUITMENT AND IMPLEMENTATION RESULTS. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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