Telehealth in geriatric oncology: A novel approach to deliver multidisciplinary care for older adults with cancer

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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Use of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in older patients with ER-positive HER2-negative breast cancer: Young International Society of Geriatric Oncology review paper

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835918809610 ◽

2018 ◽

Vol 10 ◽

pp. 175883591880961 ◽

Cited By ~ 12

Author(s):

Nicolò Matteo Luca Battisti ◽

Nienke De Glas ◽

Mina S. Sedrak ◽

Kah Poh Loh ◽

Gabor Liposits ◽

...

Keyword(s):

Breast Cancer ◽

Older Adults ◽

Older Patients ◽

Geriatric Oncology ◽

Growth Factor Receptor ◽

Standard Of Care ◽

Cyclin Dependent Kinase ◽

Current Standard ◽

Oncology Review ◽

Er Positive

The current standard of care for the management of estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer has been redefined by the introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. Although adults aged 65 years and older account for the majority of patients with breast cancer, limited data are available about the age-specific dosing, tolerability, and benefit of CDK4/6 inhibitors in this growing population. Older adults are under-represented in clinical trials and as a result, clinicians are forced to extrapolate from findings in younger and healthier patients when making treatment decisions for older patients. In this article, we review the limited age-specific evidence on the efficacy, toxicity, and quality of life (QoL) outcomes associated with the use of CDK4/6 inhibitors in older adults. We also describe ongoing trials evaluating CDK4/6 inhibitors in the older population and highlight that only a minority of adjuvant and metastatic trials of CDK4/6 inhibitors in the general breast cancer population includes geriatric assessments. Finally, we propose potential strategies to help guide decision making for fit and unfit older patients based on disease endocrine sensitivity, the need for rapid response and geriatric assessment.

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Use of the geriatric assessment in clinical practice in Mexico: A survey of cancer providers.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24013 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24013-e24013

Author(s):

Haydee Cristina Verduzco-Aguirre ◽

Laura Margarita Bolano Guerra ◽

Hector Martínez-Said ◽

Gregorio Quintero Beulo ◽

Eva Culakova ◽

...

Keyword(s):

Older Adults ◽

Clinical Practice ◽

Geriatric Assessment ◽

Geriatric Oncology ◽

Public Institution ◽

Care Providers ◽

Cross Sectional Survey ◽

Qualified Personnel ◽

Medical Oncologists ◽

Oncology Providers

e24013 Background: Despite the growing burden of cancer in older adults in Mexico, it is unknown how many cancer care providers in Mexico use information obtained through a geriatric assessment (GA) and/or geriatric oncology principles in their everyday clinical practice. Methods: We administered a cross-sectional survey to oncology providers in Mexico via the Mexican Society of Oncology mailing list (n = 1240). The survey included questions on demographics, awareness about geriatric oncology principles, and the use of the GA and other geriatric clinical tools. The primary outcome was to estimate the proportion of providers using GA tools through the question: “For your patients ≥65 years, do you perform a multidimensional geriatric assessment using validated tools?”. We hypothesized that ≤10% of respondents would give a positive answer. We used descriptive statistics and X2 tests to compare groups of respondents. Results: We obtained 196 answers (response rate 15.8%). 121 (62%) respondents were male; median age 42. 98 (50%) were surgical oncologists, 59 (30%) medical oncologists, and 38 (19%) radiation oncologists. Median time in practice was 8 years, with 39% practicing in Mexico City. A third had their practice at a public institution, 26% at a private institution, and 38% in both. The proportion of patients aged 65-79 and ≥80 seen on an average clinic day by the respondents was 30% and 10%, respectively. 121 (62%) reported having a geriatrician available at their practice site. 37 respondents (19%) reported using validated GA tools to evaluate older adults with cancer in their practice. The proportion of respondents who evaluated each GA domain is shown in Table 1. Male respondents (p=0.03), medical oncologists (p<0.01), and those with a less busy practice (≤10 patients/day) (p=0.01) were more likely to use validated tools to perform a GA. Regarding barriers for implementing GA, 37% reported lack of time, 49% lack of qualified personnel, 44% lack of knowledge of geriatric tools, 6% patient unwillingness to undergo a GA, and 8% prohibitive cost. Only 17 (9%) thought that information obtained through a GA would not lead to practice changes. Conclusions: According to our survey, the proportion of Mexican oncology providers using validated tools to perform a GA is 19%, which is higher than expected. Some GA domains, such as comorbidity and functional status, were commonly assessed, while others, such as fall history, were seldom evaluated. Common barriers for GA implementation were lack of qualified personnel and of knowledge about geriatric tools. We plan to further explore these barriers and potential facilitators through focused interviews in order to guide future interventions.[Table: see text]

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Perspectives on functional status in older adults with cancer: An interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2020.10.018 ◽

2020 ◽

Author(s):

Ginah Nightingale ◽

Nicolò Matteo Luca Battisti ◽

Kah Poh Loh ◽

Martine Puts ◽

Cindy Kenis ◽

...

Keyword(s):

Older Adults ◽

Functional Status ◽

Interest Group ◽

International Society ◽

Allied Health ◽

Geriatric Oncology

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Measuring functional status of older adults with cancer with patient and performance-based measures, a how-to guide: A young society of geriatric oncology and nursing and allied health initiative

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2020.09.025 ◽

2020 ◽

Cited By ~ 1

Author(s):

Mackenzi Pergolotti ◽

Schroder Sattar

Keyword(s):

Older Adults ◽

Functional Status ◽

Allied Health ◽

Geriatric Oncology ◽

Health Initiative ◽

And Performance

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A novel approach to predict repeatability of performance in older adults: Coefficients of variation for strength and functional measures

Journal of Science and Medicine in Sport ◽

10.1016/j.jsams.2015.12.456 ◽

2015 ◽

Vol 19 ◽

pp. e34

Author(s):

I. Selva Raj ◽

S. Bird ◽

B. Westfold ◽

A. Shield

Keyword(s):

Older Adults ◽

Functional Measures ◽

Novel Approach ◽

Coefficients Of Variation

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Variation in phrasal rhythm in sign languages

Sign Language & Linguistics ◽

10.1075/sll.00010.bre ◽

2018 ◽

Vol 21 (1) ◽

pp. 41-76 ◽

Cited By ~ 1

Author(s):

Diane Brentari ◽

Joseph Hill ◽

Brianne Amador

Keyword(s):

Older Adults ◽

American Sign Language ◽

Preliminary Investigation ◽

American Sign ◽

Rhythmic Structure ◽

Sign Languages ◽

Language Differences ◽

Novel Approach ◽

Group Variation ◽

Variability Index

Abstract In this paper. we offer a preliminary investigation of some aspects of individual and group variation in sign rate and rhythm, considering the sociolinguistic factors of Age (younger and older adults), Gender, and Sign Variety (Black and Mainstream American Sign Language). Differences in sign rate and rhythmic structure among signers were found in signers’ elicited narratives. A novel approach to phrasal rhythm is introduced, called “rhythm ratio”, which considers sign duration and transition duration together and is similar in spirit to the “normalized pairwise variability index” (nPVI) in spoken languages. This measure appears to be promising as a method for identifying rhythm class in sign languages; however, due to the small number of signers in each group these results can only be suggestive.

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Clinical trial testing in-home multidisciplinary care management for older adults with cognitive vulnerability: Rationale and study design

Contemporary Clinical Trials ◽

10.1016/j.cct.2020.105992 ◽

2020 ◽

Vol 92 ◽

pp. 105992

Author(s):

Richard H. Fortinsky ◽

George A. Kuchel ◽

David C. Steffens ◽

James Grady ◽

Marie Smith ◽

...

Keyword(s):

Older Adults ◽

Clinical Trial ◽

Study Design ◽

Care Management ◽

Cognitive Vulnerability ◽

Multidisciplinary Care ◽

Trial Testing

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Impact of a geriatric oncology (GO) clinic on cancer treatment plans and supportive care for older adults with genitourinary (GU) cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.238 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 238-238

Author(s):

Shabbir M.H. Alibhai ◽

Allison Loucks ◽

Rana Jin ◽

Martine Puts ◽

Sarah Watt ◽

...

Keyword(s):

Older Adults ◽

Supportive Care ◽

Treatment Plan ◽

Tertiary Care ◽

Geriatric Oncology ◽

Operative Management ◽

Best Supportive Care ◽

Care Hospital ◽

Treatment Plans ◽

The Impact

238 Background: Older adults with cancer are complex due to multiple comorbidities, polypharmacy, and functional/cognitive impairments, leading to over-treatment and undertreatment. Studies examining the impact of geriatric assessment (GA) in older adults with various cancers found a median of 39% of treatment plans were revised after the GA ( Ann Oncol 2014; 25:307). Although these findings support the need for a GO clinic, whether such a clinic leads to changes in treatment in patients with GU malignancies is not clear. We examined the impact on the treatment plan of a GO assessment in GU patients, along with other enhancements to patient care for consecutive patients referred to the GO clinic in a tertiary care hospital. Methods: All referred older adults (age 65+) with a GU malignancy seen in the GO clinic at the Princess Margaret Cancer Centre, Toronto, Canada between July 2015 and June 2017 were included. Patients were seen by a geriatric oncologist and GO nurse and treatment recommendations were provided to the referring oncologist. Pre- and post-GO clinic treatment plans and enhancements to supportive care were recorded prospectively. Analyses were descriptive. Results: 98 patients (mean age 80) were seen in the GO clinic, of whom 35 were seen pre-treatment (25 prostate, 5 kidney, 5 bladder). 31 of 35 were referred for input on the treatment plan. The initial treatment plan included surgery (n = 6), radiation (n = 14), systemic therapy (n = 8), and hormonal therapy (n = 11). The final treatment plan was intensified in 1 patient, reduced in 6 patients, changed to best supportive care in 8 patients, and unchanged in 15 patients. Overall, GO resulted in a treatment modification in 52% of patients. Enhancements to care included comorbidity management (87%), educational support (94%), disease-related symptoms (39%), and peri-operative management (19%). Conclusions: The GO clinic results in modifications to the proposed treatment plan in over half of referred patients (predominantly a reduction in treatment intensity), and enhancements to care in the vast majority of patients. GO clinics have the potential to avoid overtreatment and improve care for older adults with GU malignancies.

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