University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
JCO Oncol Pract. 2022 Oct;18(10):e1630-e1640. doi: 10.1200/OP.22.00173. Epub 2022 Aug 19.
Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations.
Eligible patients (ClinicalTrials.gov identifier: NCT02107443) were age ≥ 70 years, had stage III/IV solid tumor or lymphoma, were being treated with noncurative treatment intent, and ≥ 1 GA domain impairment. Patients in both arms underwent GA. At practices randomly assigned to the intervention arm, oncologists were provided a GA summary with management recommendations. In both arms, patients had one clinical encounter audio-recorded, transcribed, and coded to categorize whether a conversation about falls occurred. Generalized linear mixed models adjusted for arm, practice site, and other important covariates were used to generate proportions and odds ratios (ORs) from the full sample.
Of 541 patients (intervention N = 293 and usual care N = 248, mean age: 77 years, standard deviation: 5.3), 528 had evaluable audio recordings. More patients had conversations about falls in the intervention versus usual care arm (61.3% 10.3%, < .001). Controlling for the intervention and practice site, history of falls (OR, 2.1; 95% CI, 1.3 to 3.6; .005) and impaired physical performance (OR, 4.7; 95% CI, 1.7 to 12.8; .002) were significantly associated with patient-oncologist conversations about falls.
GA intervention increased conversations about falls. History of falls and impaired physical performance were associated with patient-oncologist conversations about falls in community oncology practice.
对于患有癌症的老年人来说，跌倒（falls）是一个可以改变的发病因素，但在肿瘤学实践中却被低估了。在这项全国性的聚类随机对照试验的二次分析中，我们研究了与患者与肿瘤医生就跌倒问题进行交流的特征，以及肿瘤医生对老年评估（GA）的了解是否会导致更多的交流。
符合条件的患者（临床试验标识符：NCT02107443）年龄≥70 岁，患有 III/IV 期实体瘤或淋巴瘤，接受非治愈性治疗，且存在≥1 个 GA 域障碍。两组患者均接受 GA。在随机分配到干预组的实践中，肿瘤医生会收到一份 GA 总结，并附有管理建议。在两组中，患者的一次临床接触都会被录音、转录，并进行分类，以确定是否进行了关于跌倒的对话。使用广义线性混合模型，根据手臂、实践地点和其他重要协变量进行调整，从全样本中生成比例和比值比（OR）。
在 541 名患者（干预组 N=293，常规护理组 N=248，平均年龄：77 岁，标准差：5.3）中，有 528 名患者的可评估音频记录。干预组较常规护理组有更多患者进行了关于跌倒的对话（61.3%[10.3%]，<.001）。在控制了干预和实践地点后，跌倒史（OR，2.1；95%置信区间，1.3 至 3.6；<.005）和身体机能受损（OR，4.7；95%置信区间，1.7 至 12.8；<.002）与患者与肿瘤医生就跌倒问题进行交流显著相关。
GA 干预增加了关于跌倒的对话。在社区肿瘤学实践中，跌倒史和身体机能受损与患者与肿瘤医生就跌倒问题进行交流相关。
