Geriatric Assessment–Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.

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How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

JCO Oncology Practice ◽

10.1200/op.20.00442 ◽

2020 ◽

pp. OP.20.00442

Author(s):

William Dale ◽

Grant R. Williams ◽

Amy R. MacKenzie ◽

Enrique Soto-Perez-de-Celis ◽

Ronald J. Maggiore ◽

...

Keyword(s):

Older Adults ◽

Geriatric Assessment ◽

Online Survey ◽

Task Force ◽

Statistical Significance ◽

Geriatric Oncology ◽

Perceived Barriers ◽

Patients With Cancer ◽

Change Behavior ◽

American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

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Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults

Blood Advances ◽

10.1182/bloodadvances.2019000790 ◽

2019 ◽

Vol 3 (22) ◽

pp. 3488-3498 ◽

Cited By ~ 11

Author(s):

Benjamin A. Derman ◽

Keriann Kordas ◽

Jean Ridgeway ◽

Selina Chow ◽

William Dale ◽

...

Keyword(s):

Older Adults ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Older Adult ◽

Geriatric Assessment ◽

Cellular Therapy ◽

Morbidity And Mortality ◽

Key Points ◽

Multidisciplinary Clinic

Key Points GA to guide an MDC evaluation to optimize older adult candidates for hematopoietic cellular therapy is feasible and practical. An MDC evaluation for older adults before transplantation holds promise to mitigate transplant-related morbidity and mortality.

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Feasibility and reliability of a self-administered geriatric assessment tool for Spanish-speaking Mexican older adults with cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2021.05.013 ◽

2021 ◽

Author(s):

Andrea Pérez-de-Acha-Chávez ◽

Carolina Gómez-Moreno ◽

José Carlos Aguilar-Velazco ◽

María Luisa Moreno-García ◽

Concepción Pérez-de-Celis-Herrero ◽

...

Keyword(s):

Older Adults ◽

Geriatric Assessment ◽

Assessment Tool ◽

Spanish Speaking

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Clinical effectiveness of geriatric assessment for predicting the tolerability of outpatient chemotherapy in older adults with cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2017.07.014 ◽

2018 ◽

Vol 9 (1) ◽

pp. 84-86 ◽

Cited By ~ 2

Author(s):

Naomi Hayashi ◽

Ayumu Matsuoka ◽

Hidemi Goto ◽

Momokazu Gotoh ◽

Hitoshi Kiyoi ◽

...

Keyword(s):

Older Adults ◽

Geriatric Assessment ◽

Clinical Effectiveness ◽

Outpatient Chemotherapy

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Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice

Hematology ◽

10.1182/hematology.2019001299 ◽

2019 ◽

Vol 2019 (1) ◽

pp. 53-58 ◽

Cited By ~ 1

Author(s):

Heidi D. Klepin

Keyword(s):

Older Adults ◽

Quality Of Care ◽

Geriatric Assessment ◽

Hematologic Malignancies ◽

Patient Centered ◽

Functional Reserve ◽

Centered Care ◽

Assessment Measures

Abstract Older adults represent the growing majority of patients diagnosed with hematologic disorders, yet they remain underrepresented on clinical trials. Older patients of the same chronologic age differ from one another with varying comorbidity and functional reserve. The concepts of frailty and resilience are important to patient-centered care and are patient and setting specific. The use of geriatric assessment to inform tailored decision making and management can personalize care for older adults with hematologic malignancies. This article will highlight available evidence to support the role of geriatric assessment measures to enhance quality of care for older adults diagnosed with hematologic malignancies.

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Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies

Frontiers in Oncology ◽

10.3389/fonc.2021.775050 ◽

2021 ◽

Vol 11 ◽

Author(s):

Sarah A. Wall ◽

Ying Huang ◽

Ashleigh Keiter ◽

Allesia Funderburg ◽

Colin Kloock ◽

...

Keyword(s):

Older Adults ◽

Geriatric Assessment ◽

Bone Marrow Failure ◽

Myeloproliferative Neoplasm ◽

Treatment Decision ◽

Hematologic Malignancies ◽

Routine Care ◽

Clinical Frailty Scale ◽

Risk Of Death ◽

Age Related

The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00–1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41–4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60–9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10–6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21–1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05–1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11–4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07–3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.

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