Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Department of Medicine, University of Rochester Medical Center, Rochester, NY.
JCO Oncol Pract. 2022 Jan;18(1):e9-e19. doi: 10.1200/OP.21.00196. Epub 2021 Jul 6.
Older patients with advanced cancer often have comorbidities that can worsen their cancer and treatment outcomes. We assessed how a geriatric assessment (GA)-guided intervention can guide conversations about comorbidities among patients, oncologists, and caregivers.
This secondary analysis arose from a nationwide, multisite cluster-randomized trial (ClinicalTrials.gov identifier: NCT02107443). Eligible patients were ≥ 70 years, had advanced cancer (solid tumors or lymphoma), and had impairment in at least one GA domain (not including polypharmacy). Oncology practices (n = 30) were randomly assigned to usual care or intervention. All patients completed a GA; in the intervention arm, a GA summary with recommendations was provided to their oncologist. Patients completed an Older Americans Resources and Services Comorbidity questionnaire at screening. The clinical encounter following GA was audio-recorded, transcribed, and coded for topics related to comorbidities. Linear mixed models examined the effect of the intervention on the outcomes adjusting for practice site as a random effect.
Patients (N = 541) were 76.6 ± 5.2 years old; 94.6% of patients had at least one comorbidity with an average of 3.2 ± 1.9. The intervention increased the average number of conversations regarding comorbidities per patient from 0.52 to 0.99 ( < .01). Moreover, there were a greater number of concerns acknowledged (0.52 0.32; = .03) and there was a 2.4-times higher odds of having comorbidity concerns addressed via referral, handout, or other modes (95% CI, 1.3 to 4.3; = .004). Most oncologists in the intervention arm (76%) discussed comorbidities in light of the treatment plan, and 41% tailored treatment plans.
Providing oncologists with a GA-guided intervention enhanced communication regarding comorbidities.
患有晚期癌症的老年患者通常患有合并症，这些合并症可能会使他们的癌症和治疗结果恶化。我们评估了老年评估（GA）指导干预如何指导患者、肿瘤学家和护理人员之间关于合并症的对话。
本二次分析源于一项全国性、多地点聚类随机试验（ClinicalTrials.gov 标识符：NCT02107443）。合格的患者年龄≥70 岁，患有晚期癌症（实体瘤或淋巴瘤），并且在至少一个 GA 领域（不包括多种药物治疗）存在功能障碍。肿瘤学实践（n=30）被随机分配到常规护理或干预组。所有患者均完成了 GA；在干预组中，为他们的肿瘤学家提供了一份包含建议的 GA 摘要。患者在筛查时完成了美国老年人资源和服务合并症问卷。GA 后的临床就诊被录音、转录，并对与合并症相关的主题进行编码。线性混合模型通过调整实践地点作为随机效应，研究了干预对结果的影响。
患者（N=541）年龄为 76.6±5.2 岁；94.6%的患者至少有一种合并症，平均有 3.2±1.9 种。干预措施使每位患者关于合并症的平均对话次数从 0.52 次增加到 0.99 次（<0.01）。此外，更多的关注问题得到了承认（0.52 vs 0.32；=0.03），通过转介、分发传单或其他方式解决合并症问题的可能性增加了 2.4 倍（95%置信区间，1.3 至 4.3；=0.004）。干预组中的大多数肿瘤学家（76%）根据治疗计划讨论合并症，41%调整了治疗计划。
为肿瘤学家提供 GA 指导干预措施增强了关于合并症的沟通。
