Using Geriatric Assessment to Guide Conversations Regarding Comorbidities Among Older Patients With Advanced Cancer

Abstract

Purpose: Older patients with advanced cancer often have comorbidities that can worsen their cancer and treatment outcomes. We assessed how a geriatric assessment (GA)-guided intervention can guide conversations about comorbidities among patients, oncologists, and caregivers.

Methods: This secondary analysis arose from a nationwide, multisite cluster-randomized trial (ClinicalTrials.gov identifier: NCT02107443). Eligible patients were ≥ 70 years, had advanced cancer (solid tumors or lymphoma), and had impairment in at least one GA domain (not including polypharmacy). Oncology practices (n = 30) were randomly assigned to usual care or intervention. All patients completed a GA; in the intervention arm, a GA summary with recommendations was provided to their oncologist. Patients completed an Older Americans Resources and Services Comorbidity questionnaire at screening. The clinical encounter following GA was audio-recorded, transcribed, and coded for topics related to comorbidities. Linear mixed models examined the effect of the intervention on the outcomes adjusting for practice site as a random effect.

Results: Patients (N = 541) were 76.6 ± 5.2 years old; 94.6% of patients had at least one comorbidity with an average of 3.2 ± 1.9. The intervention increased the average number of conversations regarding comorbidities per patient from 0.52 to 0.99 (P < .01). Moreover, there were a greater number of concerns acknowledged (0.52 v 0.32; P = .03) and there was a 2.4-times higher odds of having comorbidity concerns addressed via referral, handout, or other modes (95% CI, 1.3 to 4.3; P = .004). Most oncologists in the intervention arm (76%) discussed comorbidities in light of the treatment plan, and 41% tailored treatment plans.

Conclusion: Providing oncologists with a GA-guided intervention enhanced communication regarding comorbidities.

Conflict of interest statement

Richard F. DunneConsulting or Advisory Role: Exelixis Nicholas J. VogelzangEmployment: US OncologyStock and Other Ownership Interests: Caris Life SciencesHonoraria: UpToDate, Pfizer, Novartis, MerckConsulting or Advisory Role: Pfizer, Bayer, Genentech/Roche, AstraZeneca, Caris Life Sciences, Tolero Pharmaceuticals, Merck, Astellas Pharma, Boehringer Ingelheim, Corvus Pharmaceuticals, Modra Pharmaceuticals, Clovis Oncology, Janssen Oncology, Eisai, Myovant SciencesSpeakers' Bureau: Bayer, Sanofi, Genentech/Roche, Bristol Myers Squibb, Seattle Genetics/Astellas, Clovis Oncology, AVEO, Myovant Sciences, AstraZenecaResearch Funding: US Oncology, Endocyte, Merck, Suzhou Kintor PharmaceuticalsExpert Testimony: NovartisTravel, Accommodations, Expenses: Genentech/Roche, US Oncology, Pfizer, Bayer/Onyx, Exelixis, AstraZeneca/MedImmune, Sanofi/Aventis Luke J. PepponeConsulting or Advisory Role: Charlotte's Web Supriya G. MohileConsulting or Advisory Role: Seattle GeneticsResearch Funding: CareviveNo other potential conflicts of interest were reported.

Figures

FIG 1.

The extent to which comorbidities interfere with activities of daily living (Older American Resources and Services Comorbidity questionnaire at screening, n = 540).

FIG 2.

Conversations related to comorbidities. (A) The percent of patients who had the condition at baseline and discussed the condition during their clinic visit. Comorbidities are given, with those interfering with activities a great deal on the left, and those that tend not to interfere as much on the right. (B) Who initiated the conversation in the usual care group and (C) who initiated the conversation in the intervention group. The oncologist initiated a greater number of conversations in the intervention arm than in the usual care arm (P = .01).