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optimize patients in advance of surgery. Similarly the higher
number of interventions from social care in the palliative
patient group may reflect their need for increased social
support in the face of their decline in function.
References:
[1]
http://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/ca
ncerregistrationstatisticsengland/2014#cancer-diagnoses-
increase-with-age accessed June2016
[2] Wilder H, Heeren P, Puts M et al International Society of
Geriatric Oncology Consensus on Geriatric Assessment in
Older PeopleWith Cancer Journal of Clinical Oncology 2014
Vol 32 Number 24 p2595-2603
[3] Kristjansson S R, Spies C, Veering B.T.H et al Perioperative
care of the elderly oncology patient : A report from the
SIOG task force on the perioperative care of older patients
with cancer. Journal of Geriatric Oncology 2012 volume 3
p147-162.
Disclosure of interest:
None declared
Keywords:
Comprehensive geriatric assessment,
multidisciplinary team, upper GI cancer
O20
A FEASIBILITY TRIAL OF GERIATRIC ASSESSMENT AND
INTEGRATED CARE PLAN FOR OLDER CANCER PATIENTS
M. Puts
1,
*, S. Sattar
1
, K. McWatters
1
, K. Lee
1
, M. Kulik
1
,
M. E. Macdonald
1
, S. Brennenstuhl
1
, R. Jang
2
,
E. Amir
2
, M. Krzyzanowska
2
, A. Joshua
2,3
, J. Monette
4
,
D. Wan-Chow-Wah
5
, S. Alibhai
6,7
1
Lawrence S.Bloomberg Faculty of Nursing, University of Toronto,
2
Medical Oncology, University Health Network, Toronto, Canada,
3
Medical Oncology, Kinghorn Cancer Centre, Sydney, Australia,
4
Division of Geriatric Medicine, Jewish General Hospital,
5
Division
of Geriatric Medicine, McGill University Health Centre, Montreal,
6
Medicine, University Health Network,
7
Medicine, University of
Toronto, Toronto, Canada
Introduction:
A Feasibility Trial of Geriatric Assessment
and Integrated Care Plan for Older Cancer Patients
Objectives:
The majority of persons diagnosed with cancer
are older adults A comprehensive geriatric assessment
(CGA) can identify current health issues and recommend
interventions to decrease adverse outcomes and optimize
the functional status and well-being of older adults. However,
there is limited and conflicting evidence regarding the
effectiveness of CGA in oncology settings. Here, we explore
the impact of a CGA and integrated care plan in optimizing
outcomes in older patients with advanced breast (BC),
gastrointestinal (GI) or genitourinary (GU) cancers using a
randomized controlled trial.
Methods:
A two-group parallel single-blind phase II RCT
enrolled 60 patients aged 70 +, diagnosed with stage 2-4 GI, GU
or BC, referred for chemotherapy or having received <6 weeks
of chemotherapy at the Princess Margaret Cancer Centre,
Toronto, Canada. Patients needed to be fluent in English, had
a life expectancy
6 months, ECOG PS 0-2 and able to provide
informed consent. Randomization to intervention versus
control group was 1:1 and stratified by treatment intent.
The intervention included a full CGA by a multidisciplinary
team. Based on the CGA and discussion with the patient,
tailored evidence-based interventions using a standardized
intervention protocol were implemented. Participants in the
intervention group were seen by the intervention team at
baseline for the CGA and development of the integrated care
plan; and at 3 and 6 months to assess intervention fidelity and
measure outcomes. The co-primary outcomes were: 1) quality
of life (QoL) (EORTC QLQ-C30); 2) modification of the cancer
treatment plan. The secondary outcomes are: 1) functional
status (OARS Instrumental Activities of Daily Living); and 2)
feasibility of the study by tumor site.
Results:
The response rate was 64%. The mean age
of participants in the control group was 75.4 and in the
intervention group 74.7 year. Eighty percent received
chemotherapy with palliative intent in the intervention
group. In both groups about 30% of participants died before
the end of the 6 month follow-up. QoL declined from baseline
to 3 months in both groups; however, the decline was larger
in the control than the intervention group (-6.9 vs. -2.0 points),
especially when considering only those remaining in the
study for at least 6 months (-9.8 vs. -2.8). Modeling the data
using linear regression suggests QoL is 7.1 to 9.3 points higher
in the intervention group at 3 months, adjusting for baseline
differences (p=.34-.38), depending on which subsample is
used.The intervention had no impact on the cancer treatment
plan.The proportion of those with at least one IADL was lower
in the intervention than control group at 3 months, when
adjusting for baseline differences in IADLs (OR
adj
=0.40, p=0.25
95% CI 0.08-1.88).
Conclusion:
This phase 2 pilot study showed that it was
feasible to recruit and retain older adults for a geriatric
assessment and management study. The preliminary efficacy
evaluations showed that the value of GA and management
on change in QoL was greater in the sub-sample of longer-
term survivors/participants than in the whole sample, and
functional decline may be less in the intervention group. A
larger trial is warranted.
Disclosure of interest:
None declared
Keywords:
feasibility study, Geriatric assessment, integrated
care plan, intervention study, randomized controlled trial