Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Department of Medicine, Institute of Health Policy, Management, and Evaluation, University Health Network, University of Toronto, Toronto, Canada.
J Geriatr Oncol. 2019 Jan;10(1):169-174. doi: 10.1016/j.jgo.2018.06.014. Epub 2018 Jul 21.
Geriatric Assessment (GA) can help uncover previously unknown health issues and recommend tailored interventions to optimize outcomes; however, no completed randomized trial has examined the impact of GA on utility-based health status, healthcare use, and oncologists' opinions about GA. We examined these secondary outcomes of a randomized phase II trial.
A planned analysis of secondary outcomes of a two-group parallel single-blind randomized phase II trial of GA (ClinicalTrials.gov Identifier:NCT02222259) recruited patients ≥ age 70, diagnosed with stage II-IV breast/gastrointestinal/genitourinary cancer within six weeks of beginning chemotherapy at the Princess Margaret Cancer Centre, Toronto, Canada. Descriptive analyses using intent-to-treat were conducted for health status (EuroQol EQ-5D-3L) and healthcare utilization (patient self-report). Oncologist opinions were captured via open-ended interviews and summarized.
A total of 95 patients who met the inclusion criteria were approached; 61 of them consented (64%). For health status, at all time-points, there were no significant differences between the two groups. The number of emergency department and family physician visits was low overall; there were no statistically significant differences between the two groups at any time point. All interviewed oncologists (eight of fourteen invited) were satisfied with the intervention, but wanted more straightforward recommendations and earlier GA results.
No difference was found in terms of relationships between GA and utility-based health status or GA and healthcare use. Underreporting of healthcare use was possible. Oncologists welcome GA feedback and prefer to receive it in pre-treatment decision context. Larger trials with earlier GA are warranted.
老年综合评估（GA）可以帮助发现以前未知的健康问题，并推荐量身定制的干预措施，以优化结果；然而，没有已完成的随机试验研究过 GA 对基于效用的健康状况、医疗保健使用以及肿瘤医生对 GA 的看法的影响。我们研究了这项随机 II 期试验的次要结果。
对 GA 的两组成平行单盲随机 II 期试验（ClinicalTrials.gov 标识符：NCT02222259）的次要结果进行了计划分析，该试验在加拿大安大略省多伦多玛格丽特公主癌症中心招募了年龄≥70 岁、在开始化疗后六周内被诊断患有 II-IV 期乳腺/胃肠道/泌尿生殖系统癌症的患者。采用意向治疗进行健康状况（EuroQol EQ-5D-3L）和医疗保健利用（患者自我报告）的描述性分析。通过开放式访谈收集肿瘤医生的意见并进行总结。
共有 95 名符合纳入标准的患者被接触，其中 61 名同意（64%）。在所有时间点，两组的健康状况均无显著差异。总的来说，急诊室和家庭医生就诊次数较低；两组在任何时间点均无统计学差异。所有接受采访的肿瘤医生（14 名受邀医生中的 8 名）对干预措施感到满意，但希望得到更直接的建议和更早的 GA 结果。
GA 与基于效用的健康状况或 GA 与医疗保健使用之间没有发现关系差异。医疗保健使用的低报可能存在。肿瘤医生欢迎 GA 反馈，并希望在治疗前决策背景下收到反馈。需要进行更大规模、更早进行 GA 的试验。
