How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study. Issue 6 (November 2019)

• Record Type: Journal Article
• Authors: Festen, Suzanne; Kok, Maaike; Hopstaken, Jana S.; van der Wal-Huisman, Hanneke; van der Leest, Annya; Reyners, Anna K.L.; de Bock, Geertruida H.; de Graeff, Pauline; van Leeuwen, Barbara L.
• Is Part Of: Journal of geriatric oncology. Volume 10:Issue 6(2019)
• Page Start: 951
• Page End: 959
• Publication Date: 2019-11
• Subjects: Geriatric assessment -- Patient preferences -- Clinical decision-making -- Older patients with cancer -- Implementation -- OPT tool; ADL Activities of daily living -- CCI Charlson comorbidity index -- CGA Comprehensive geriatric assessment -- GA Geriatric assessment -- GARS Groningen activity restriction scale -- GFI Groningen frailty indicator -- iADL Instrumental activities of daily living -- LFT Letter fluency test -- MDT Multidisciplinary team -- NTR Netherlands trial registry -- OPT Outcome prioritization tool -- TUG Timed up and go test; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2019.04.006
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Introduction: With the accumulating evidence on the added value on prediction of outcomes of geriatric assessment (GA) in older patients with cancer, the question shifts from whether performing a GA is useful, to how to implement this into standard practice in a feasible and effective way. The effect of implementing GA, and assessment of patient preferences on treatment recommendations by an onco-geriatric multidisciplinary team (MDT), was compared to the recommendation previously made by the tumor board (care as usual). Methods: Patients aged 70 years and older with a solid malignancy who were referred to a tertiary care center for diagnosis and treatment recommendations, as provided by a tumor board, were included. The intervention consisted of: a nurse-led GA and assessment of patient preferences prior to the start of oncological treatment, discussing this in an onco-geriatric MDT, and weighing all this information in a structured, stepwise manner. Treatment recommendations formulated by this onco-geriatric MDT were compared to the treatment recommendations by the tumor board. Results: Of 236 eligible patients, 197 were included. For 27%, treatment recommendations from the onco-geriatric MDT differed from the recommendations formulated by the tumor board. These modifications were mostly towards less intensive curative or palliative treatment. Thirteen percent of patients were subsequently referred to a geriatrician in order to reach a treatment recommendation. Discussion: Implementing an onco-geriatric care trajectory, using GA and assessment of patient preferences, resulted in an adjustment of treatment recommendations for a quarter of patients. Thirteen percent needed subsequent referral to a geriatrician.