Geriatric Assessment for Cancer Survivorship

Overseen By Joseph Mosholder

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Francisco

Disqualifiers: Advanced dementia, Nursing home resident

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 4-6 months

70 Participants Needed

Trial Summary

What is the purpose of this trial?

The researchers want to find out if older adults receiving a survivorship care plan followed by a geriatric assessment visit improves quality of life and satisfaction with care compared to receiving only a survivorship care plan for older adults who have completed chemotherapy for cancer treatment.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Geriatric Assessment, Geriatric Evaluation, Comprehensive Geriatric Assessment, CGA for cancer survivorship?

Research shows that a Comprehensive Geriatric Assessment (CGA) helps create personalized treatment plans for older cancer patients by identifying health issues that affect their ability to handle cancer treatment. It also aids in decision-making and predicting outcomes, making it a valuable tool in oncology care for the elderly. ^{1 2 3 4 5}

Is the Comprehensive Geriatric Assessment (CGA) safe for older cancer patients?

The Comprehensive Geriatric Assessment (CGA) is generally considered safe for older cancer patients. It is a method used to evaluate various aspects of an older person's health, such as their physical and mental abilities, nutrition, and social support, to help guide their cancer treatment. ^{2 6 7 8 9}

How is the Comprehensive Geriatric Assessment treatment different from other cancer treatments?

The Comprehensive Geriatric Assessment (CGA) is unique because it evaluates various aspects of an older cancer patient's life, including their physical health, mental state, social support, and medication use, to tailor their cancer treatment. Unlike standard treatments that focus solely on the cancer itself, CGA provides a holistic view to improve overall care and outcomes for older adults. ^{2 4 10 11 12}

Research Team

Haifaa Abdulhaq, MD

Principal Investigator

University of California, San Francisco

Eligibility Criteria

This trial is for adults aged 65 or older who have finished chemotherapy with the goal of curing cancer. They must be scheduled to receive a survivorship care plan from an oncology navigator and able to participate in interviews. It's not for those with advanced dementia, serious cognitive issues, or nursing home residents.

Inclusion Criteria

I am 65 years old or older.

I have cancer and finished chemotherapy aimed at curing it.

I am scheduled to get a care plan from a cancer care specialist.

Exclusion Criteria

I live in a nursing home.

I do not have advanced dementia or serious cognitive issues that would prevent me from participating in an interview.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a survivorship care plan, with some receiving an enhanced plan including a geriatric assessment

4-6 months

Multiple visits (in-person and virtual)

Follow-up

Participants are monitored for satisfaction, quality of life, and knowledge after receiving the survivorship care plan

4-6 months

Treatment Details

Interventions

• Geriatric Assessment

Trial Overview The study is testing if adding a geriatric assessment visit after giving older adults a survivorship care plan can improve their quality of life and satisfaction with care post-chemotherapy compared to just receiving the care plan alone.

Participant Groups

Group I: No intervention arm Active Control 1 Intervention

routine care only; will not be scheduled for comprehensive geriatric assessment

Group II: Active comparator arm Active Control 1 Intervention

those that will be scheduled for comprehensive geriatric assessment with a geriatric nurse practitioner or physician

Who Is Running the Clinical Trial?

University of California, San Francisco

Lead Sponsor

Trials

2,636

Recruited

19,080,000+

Findings from Research

A comprehensive geriatric assessment (CGA) is increasingly recognized as a valuable tool for evaluating the overall health of elderly cancer patients, which can aid in treatment decisions and predict outcomes.

While CGA shows promise in oncology, there are practical challenges in its application that may affect its integration into standard clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The comprehensive geriatric assessment in oncology: promises, pitfalls, and practicalities. Horgan, AM., Knox, JJ., Alibhai, SM.[2015]

A comprehensive geriatric assessment (CGA) can effectively predict morbidity and mortality in older cancer patients, highlighting its importance in oncology care.

Incorporating a CGA into the evaluation process helps identify issues that may be overlooked, suggesting that it can significantly improve the quality of care for older adults with cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive geriatric assessment for older patients with cancer. Extermann, M., Hurria, A.[2022]

The Comprehensive Geriatric Assessment (CGA) program at Metro North Hospital identified health issues in older cancer patients, with 59% of the 1380 patients screened showing impairments that warranted further assessment.

The most common issues found through CGA included mobility problems, malnutrition, polypharmacy, and low mood, indicating that tailored interventions can significantly support older patients undergoing cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Our experience of nursing/allied health practitioner led geriatric screening and assessment of older patients with cancer - a highly accessible model of care. Thaker, DA., McGuire, P., Bryant, G., et al.[2021]

In a study of 202 older cancer patients, those with lower Mini Nutritional Assessment (MNA) and Mini Mental State Examination (MMSE) scores were less likely to complete chemotherapy, indicating that these assessments can help identify patients at higher risk for treatment complications.

The study found that patients with low MNA scores and high Groningen Frailty Index (GFI) scores had significantly increased mortality rates after starting chemotherapy, highlighting the importance of comprehensive geriatric assessments in predicting outcomes for elderly cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Aaldriks, AA., Maartense, E., le Cessie, S., et al.[2015]

The pilot study involving 25 geriatric cancer patients showed that implementing a comprehensive geriatric assessment (CGA) in a busy oncology clinic is feasible, although it faced some logistical challenges.

Patients reported feeling grateful for the additional time and attention provided during the CGA process, highlighting its potential psychosocial benefits, even though only minor changes in health domains were observed from before to after chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a comprehensive geriatric assessment tool in geriatric cancer patients undergoing adjuvant chemotherapy: a pilot study. Koneru, R., Freedman, O., Lemonde, M., et al.[2021]

A comprehensive geriatric assessment (CGA) in 65 elderly cancer patients revealed that many had undetected health issues, such as functional impairments and malnutrition, highlighting the importance of CGA in this population.

The study found that 40% of patients experienced depression and 51% had mild cognitive impairment, indicating that CGA can help identify critical areas of concern that may affect treatment tolerance and overall quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy. Kim, YJ., Kim, JH., Park, MS., et al.[2021]

A study involving 494 elderly cancer patients (median age 75) found that three specific items from the Mini Nutritional Assessment (MNA) can predict the feasibility of chemotherapy, helping to streamline patient assessments.

The Geriatric Prognostic Index (GPI), based on three items, effectively identifies elderly patients at higher risk for mortality, with increasing hazard ratios indicating greater risk with more positive items.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly. Aaldriks, AA., Maartense, E., Nortier, HJ., et al.[2022]

A study involving 494 elderly cancer patients (median age 75) found that three specific items from the Mini Nutritional Assessment (MNA) can predict the feasibility of chemotherapy, helping to streamline patient assessments.

The Geriatric Prognostic Index (GPI), based on three items, effectively identifies elderly patients at higher risk for mortality, with increasing hazard ratios indicating greater risk with more positive items.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly. Aaldriks, AA., Maartense, E., Nortier, HJ., et al.[2016]

The comprehensive geriatric assessment (CGA) utilized various tests to evaluate the health and functional status of older cancer patients, highlighting areas of limitation in their care.

Most CGA recommendations focused on general cancer treatment strategies, with additional emphasis on fall prevention and education, indicating a holistic approach to managing the health of elderly patients in oncology.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive Geriatric Assessment: Interprofessional Team Recommendations for Older Adult Women With Breast Cancer Overcash, J.[2019]

Comprehensive geriatric assessment (CGA) is crucial for evaluating frail elderly cancer patients, as it considers various factors like functional, physical, and mental health, which can influence treatment outcomes.

By using CGA, healthcare providers can better identify which elderly patients are suitable for aggressive cancer treatment versus those who would benefit more from supportive care, potentially increasing their inclusion in clinical trials and improving their overall management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive geriatric assessment. Wieland, D., Hirth, V.[2017]

A new cancer-specific Comprehensive Geriatric Assessment (CGA) was developed for older cancer patients, which was completed by 99 participants with a mean age of 78.65 years in an average time of 12.9 minutes.

Most patients found the CGA to be satisfactory in length and easy to complete, indicating its feasibility as a tool for assessing the needs of older cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a cancer-specific Comprehensive Geriatric Assessment in a University Hospital in Spain. Molina-Garrido, MJ., Guillén-Ponce, C.[2022]

Comprehensive geriatric assessment (CGA) is feasible in radiation oncology, with studies indicating that it can help identify vulnerable patients who may be at higher risk of mortality, as shown by significant associations in two studies.

While CGA may influence treatment decision-making, its impact on treatment tolerance was not statistically significant, suggesting that while it can help in patient selection, its role in improving treatment outcomes may need further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of Comprehensive Geriatric Assessment and Geriatric Screening for Older Adults in the Radiation Oncology Setting: A Systematic Review. Szumacher, E., Sattar, S., Neve, M., et al.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

The comprehensive geriatric assessment in oncology: promises, pitfalls, and practicalities. [2015]

2. United States pubmed.ncbi.nlm.nih.gov

Comprehensive geriatric assessment for older patients with cancer. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Our experience of nursing/allied health practitioner led geriatric screening and assessment of older patients with cancer - a highly accessible model of care. [2021]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. [2015]

5. Germany pubmed.ncbi.nlm.nih.gov

Evaluation of a comprehensive geriatric assessment tool in geriatric cancer patients undergoing adjuvant chemotherapy: a pilot study. [2021]

6. Germany pubmed.ncbi.nlm.nih.gov

Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly. [2016]

9. United States pubmed.ncbi.nlm.nih.gov

Comprehensive Geriatric Assessment: Interprofessional Team Recommendations for Older Adult Women With Breast Cancer [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Comprehensive geriatric assessment. [2017]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Development of a cancer-specific Comprehensive Geriatric Assessment in a University Hospital in Spain. [2022]

12. England pubmed.ncbi.nlm.nih.gov

Use of Comprehensive Geriatric Assessment and Geriatric Screening for Older Adults in the Radiation Oncology Setting: A Systematic Review. [2019]