A Geriatric Oncology Collaborative Care Intervention for Older Adults With Advanced Cancer

The purpose of this research study is to develop a geriatric oncology collaborative care intervention to enhance the quality of life, symptom burden, and functional outcomes of older adults with advanced gastrointestinal (GI) and genitourinary (GU) cancers.

Study Overview

• Status: Completed
• Conditions: Other Cancer
• Intervention / Treatment: Other: Geriatric Oncology Collaborative Care; Other: Usual Care

Detailed Description

Cancer disproportionately affects older adults, and the number of older adults with cancer is expected to grow as the population ages. Older adults with advanced cancer often possess a distinct set of medical and psycho-social issues that makes caring for the geriatric oncology population challenging for oncologists. Currently, a critical knowledge gap exists regarding how best to deliver comprehensive cancer care targeting the unique geriatric and palliative care needs of these individuals. The investigators propose to develop a geriatric oncology collaborative care intervention to improve supportive care outcomes for older adults with advanced gastrointestinal (GI) and genitourinary (GU) cancer. GI and GU cancers are among the leading causes of cancer death in the geriatric cancer population, and patients with advanced GI and GU cancers experience a high symptom burden. The intervention will entail visits with an oncology advanced practice nurse trained to address patients' unique needs, who will meet regularly with a supervising team of geriatric, palliative care, social work, and pharmacy clinicians for feedback and iterative reevaluation of the care plan. Using nurses who are already integrated into the oncology setting represents a scalable model that addresses the workforce shortage of geriatric and palliative care clinicians. The investigators used conceptual models for collaborative care and geriatric interventions to develop an initial intervention framework, and prior research to develop a preliminary intervention manual. In Aim 1, the investigators will refine and finalize both the intervention and the intervention manual based on qualitative data from patients, caregivers, and clinicians to ensure the intervention targets the unique needs of older adults with advanced cancer. In Aim 2, the investigators will modify the intervention and study methods with an open pilot study (n=10). In Aim 3, the investigators will conduct a pilot randomized trial (n=75) to assess the feasibility and preliminary efficacy of the geriatric oncology collaborative care intervention for improving patients' QOL, symptom burden, and functional outcomes.

• Study Type: Interventional
• Enrollment (Actual): 91
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02214
      • Massachusetts General Hospital Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age 65 or older
• Diagnosed with advanced (defined as metastatic or receiving therapy with palliative intent) esophageal, gastric, pancreas, hepatobiliary, colorectal, renal, bladder, or prostate cancer within the past 8 weeks (includes patients with a new diagnosis, progression or recurrence).
• ECOG performance status of 0-2
• Ability to read and respond to questions in English
• Planning to receive care at MGH

Exclusion Criteria:

- Uncontrolled psychiatric illness or impaired cognition

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Geriatric Oncology Collaborative Care; Patients receive three visits with a trained study nurse. At each visit, the study nurse will assess the patient's symptom burden, functional status, comorbid conditions, psychosocial issues, and medication use. The nurses can refer patients to specialists as needed. The study nurses will meet with a supervising support team, consisting of clinicians from geriatrics, palliative care, social work, and pharmacy to discuss each patient and review documentation. Following the team meetings, the nurses will document recommendations in the medical record and communicate with the primary oncology team, either in person or via phone, as appropriate. The study nurses will contact the supervising team in between meetings for any urgent issues or questions that arise.	Other: Geriatric Oncology Collaborative Care; Patients receive three visits with a trained study nurse. At each visit, the study nurse will assess the patient's symptom burden, functional status, comorbid conditions, psychosocial issues, and medication use. The nurses can refer patients to specialists as needed. The study nurses will meet with a supervising support team, consisting of clinicians from geriatrics, palliative care, social work, and pharmacy to discuss each patient and review documentation. Following the team meetings, the nurses will document recommendations in the medical record and communicate with the primary oncology team, either in person or via phone, as appropriate. The study nurses will contact the supervising team in between meetings for any urgent issues or questions that arise.
Active Comparator: Usual Care; Participants assigned to receive usual oncology care will not meet with the study nurses, though they may receive geriatric or palliative care consults at their request or at the discretion of their treating oncologist.	Other: Usual Care; Participants assigned to receive usual oncology care will not meet with the study nurses, though they may receive geriatric or palliative care consults at their request or at the discretion of their treating oncologist.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rates of study enrollment	To demonstrate feasibility, investigators will calculate rates of study enrollment (proportion of eligible patients who enroll in the study).	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rates of study completion	To demonstrate feasibility, investigators will calculate rates of study completion (the proportion of participants who complete all study outcome assessments).	3 years
Change in Quality of Life	Compare change in QOL (measured with the Functional Assessment of Cancer Therapy (FACT) - General) between treatment groups from baseline to 4 and 6 months.	6 Months
Longitudinal effects of the intervention on Quality of Life	To determine longitudinal effects of the intervention on QOL (measured with the Functional Assessment of Cancer Therapy (FACT) - General), investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in QOL across multiple time points (e.g. baseline, four months, and six months).	6 months
Change in Symptom Burden	Compare change in symptom burden Burden (measured with the Edmonton Symptom Assessment System-revised (ESAS-r)) between treatment groups from baseline to 4 and 6 months.	6 months
Longitudinal effects of the intervention on Symptom Burden	To determine longitudinal effects of the intervention on symptom burden (measured with the Edmonton Symptom Assessment System-revised (ESAS-r)), investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in symptom burden across multiple time points (e.g. baseline, four months, and six months).	6 months
Change in depression symptoms	Compare change in depression symptoms (measured with the 15-item Geriatric Depression Scale (GDS) with higher scores indicating greater depressive symptoms) between treatment groups from baseline to 4 and 6 months.	6 months
Longitudinal effects of the intervention on Depression Symptoms	To determine longitudinal effects of the intervention on depression symptoms (measured with the Geriatric Depression Scale (GDS)), investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in depression symptoms across multiple time points (e.g. baseline, four months, and six months).	6 months
Cange in psychological distress	Compare change in psychological distress (measured with the PHQ-4) between treatment groups from baseline to 4 and 6 months.	6 months
Longitudinal effects of the intervention on psychological distress	To determine longitudinal effects of the intervention on psychological distress (measured with the PHQ-4), investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in psychological distress across multiple time points (e.g. baseline, four months, and six months).	6 months
Change in Activities of Daily Living	Compare change in Activities of Daily Living (measured with the Medical Outcomes Study) between treatment groups from baseline to 4 and 6 months.	6 months
Longitudinal effects of the intervention on Activities of Daily Living	To determine longitudinal effects of the intervention on Activities of Daily Living (measured with the Medical Outcomes Study), investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in Activities of Daily Living across multiple time points (e.g. baseline, four months, and six months).	6 months
Change in Instrumental Activities of Daily Living	Compare change in Instrumental Activities of Daily Living (measured with the Multidimensional Functional Assessment Questionnaire from the Older American Resources and Services (OARS)) between treatment groups from baseline to 4 and 6 months.	6 months
Longitudinal effects of the intervention on Instrumental Activities of Daily Living	To determine longitudinal effects of the intervention on Instrumental Activities of Daily Living (measured with the Multidimensional Functional Assessment Questionnaire from the Older American Resources and Services (OARS)), investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in Instrumental Activities of Daily Living across multiple time points (e.g. baseline, four months, and six months).	6 months
Change in number of falls	Compare change in number of falls in the past 6 months between treatment groups from baseline to 4 and 6 months.	6 months
Longitudinal effects of the intervention on number of falls	To determine longitudinal effects of the intervention on number of falls in the past 6 months, investigators will use mixed effects models, accounting for repeated measures data and adjusting for relevant covariates (e.g. age and sex) when examining change between groups in number of falls in the past 6 months across multiple time points (e.g. baseline, four months, and six months).	6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age as a moderator of the effect of the intervention on quality of life	The investigators will explore patients' age as a potential moderator on the effect of the intervention on quality of life (measured with the Functional Assessment of Cancer Therapy (FACT) - General).	6 months
Age as a moderator of the effect of the intervention on symptom burden	The investigators will explore patients' age as a potential moderator on the effect of the intervention on symptom burden (measured with the Edmonton Symptom Assessment System-revised (ESAS-r)).	6 months
Age as a moderator of the effect of the intervention on functional outcomes	The investigators will explore patients' age as a potential moderator on the effect of the intervention on functional outcomes (Activities of Daily Living measured with the Medical Outcomes Study and Instrumental Activities of Daily Living measured with the Multidimensional Functional Assessment Questionnaire from the Older American Resources and Services (OARS)).	6 months
Sex as a moderator of the effect of the intervention on quality of life	The investigators will explore patients' sex as a potential moderator on the effect of the intervention on quality of life (measured with the Functional Assessment of Cancer Therapy (FACT) - General).	6 months
Sex as a moderator of the effect of the intervention on symptom burden	The investigators will explore patients' sex as a potential moderator on the effect of the intervention on symptom burden (measured with the Edmonton Symptom Assessment System-revised (ESAS-r)).	6 months
Sex as a moderator of the effect of the intervention on functional outcomes	The investigators will explore patients' sex as a potential moderator on the effect of the intervention on functional outcomes (Activities of Daily Living measured with the Medical Outcomes Study and Instrumental Activities of Daily Living measured with the Multidimensional Functional Assessment Questionnaire from the Older American Resources and Services (OARS)).	6 months
Cancer type as a moderator of the effect of the intervention on quality of life	The investigators will explore patients' cancer type as a potential moderator on the effect of the intervention on quality of life (measured with the Functional Assessment of Cancer Therapy (FACT) - General).	6 months
Cancer type as a moderator of the effect of the intervention on symptom burden	The investigators will explore patients' cancer type as a potential moderator on the effect of the intervention on symptom burden (measured with the Edmonton Symptom Assessment System-revised (ESAS-r)).	6 months
Cancer type as a moderator of the effect of the intervention on functional outcomes	The investigators will explore patients' cancer type as a potential moderator on the effect of the intervention on functional outcomes (Activities of Daily Living measured with the Medical Outcomes Study and Instrumental Activities of Daily Living measured with the Multidimensional Functional Assessment Questionnaire from the Older American Resources and Services (OARS)).	6 months
Comorbid conditions as a moderator of the effect of the intervention on quality of life	The investigators will explore patients' comorbid conditions as a potential moderator on the effect of the intervention on quality of life (measured with the Functional Assessment of Cancer Therapy (FACT) - General).	6 months
Comorbid conditions as a moderator of the effect of the intervention on symptom burden	The investigators will explore patients' comorbid conditions as a potential moderator on the effect of the intervention on symptom burden (measured with the Edmonton Symptom Assessment System-revised (ESAS-r)).	6 months
Comorbid conditions as a moderator of the effect of the intervention on functional outcomes	The investigators will explore patients' comorbid conditions as a potential moderator on the effect of the intervention on functional outcomes (Activities of Daily Living measured with the Medical Outcomes Study and Instrumental Activities of Daily Living measured with the Multidimensional Functional Assessment Questionnaire from the Older American Resources and Services (OARS)).	6 months

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Ryan D. Nipp, Massachusetts General Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 14, 2019
• Primary Completion (Actual): March 31, 2022
• Study Completion (Actual): March 31, 2022

Study Registration Dates

• First Submitted: October 19, 2018
• First Submitted That Met QC Criteria: October 24, 2018
• First Posted (Actual): October 26, 2018

Study Record Updates

• Last Update Posted (Actual): April 7, 2022
• Last Update Submitted That Met QC Criteria: April 6, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Keywords: Other Cancer
• Other Study ID Numbers: 18-389; K12CA087723 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No