The use of geriatric assessment in routine care of older patients with advanced cancer may significantly improve doctor-patient communication.
Providing geriatric assessment summaries for oncologists may increase the number and quality of discussions about age-related concerns and improve patient satisfaction, according to a new randomized study (abstract LBA10003) presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 1–5 in Chicago. Investigators found that the use of geriatric assessment in routine care of older patients with advanced cancer significantly improved doctor-patient communication about age-related concerns, as well as patient satisfaction with the communication.
“As oncologists, we need to step away from focusing solely on the cancer,” said lead study author Supriya Gupta Mohile, MD, MS, from the James Wilmot Cancer Center at the University of Rochester, in New York. “While living longer is important, there are many non–cancer-related health issues that are as, if not more, important.”
Dr. Mohile said this is the first randomized study to show that geriatric assessment improves doctor-patient communication. The researchers randomly assigned 31 community oncology practices to either a geriatric-assessment group or a usual-care group. The study included 542 patients (70 years of age or older) with incurable, advanced solid tumors or lymphoma. The patients also had an impairment in at least one measure included in the geriatric assessment performed at study enrollment.
The measures included function, physical performance (balance, falls, and physical health), comorbidities, nutrition, social support, depression, and cognition. As part of the geriatric assessment, physical performance and cognition measures were assessed through objective tests given by trained coordinators. Other measures were self-reported through validated questionnaires. On average, the questionnaires took patients 30 to 45 minutes to complete and the objective tests took 10 minutes to complete in the clinic.
Although patients in both study arms received geriatric assessment, only oncologists in the geriatric assessment arm received a web-based summary of results from the assessment, with recommendations for interventions for each patient prior to the next clinic visit. In the usual-care group, physicians were informed if geriatric assessment revealed a patient had significantly impaired cognition or depression, but they received no overall summary of results of the assessments or recommendations for care.
In the geriatric-assessment arm, there was a mean of 3.5 more discussions about age-related concerns during the clinic visits, compared with the usual-care arm. On average, there were 2 more high-quality doctor-patient conversations in the geriatric-assessment arm than in the usual-care arm.
These 2 additional discussions led to interventions in the geriatric-assessment arm. The interventions included physical therapy evaluation for patients with a history of falls, and reducing or eliminating high-risk medications for a patient taking more than five prescription medications. Patients in the geriatric-assessment arm had significantly more discussions about almost all age-related concerns that are measured by geriatric assessment. The study showed that patients’ satisfaction with communication with their doctor was 1.12 points higher in the geriatric-assessment arm, suggesting that patients valued discussions about age-related concerns.
In a recently published clinical practice guideline, ASCO recommended that geriatric assessment be used to identify vulnerabilities that are not routinely captured in oncology assessments in all patients 65 years of age and older who are receiving chemotherapy. Research suggests geriatric assessment is most widely used in major cancer centers with geriatric oncology programs, but seldom used in other practice settings.