Geriatric Consultation Did Not Significantly Improve Survival in Hematologic Malignancies But Increased End of Life Care Discussions

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

Geriatric consultations vs standard of care for patients with hematologic malignancies who were pre-frail or frail did not significantly improve survival at 1 year but did increase discussions on end-of-life goals of care.

Older adults with hematologic malignancies who received geriatric consultation did not have an improvement in survival at 1 year vs standard of care (SOC), although an increase in end-of-life care goal discussions were reported, according to a study published in Haematologica.

The 1 year overall survival rate in the geriatric consultation arm was 81.7% (95% CI, 71.0%-90.2%) of patients with a geriatric consultation did not have improved survival compared with 78.8% (95% CI, 69.7%-85.7%) in the SOC arm (difference 2.9%; 95% CI, –9.5% to 15.2%; P = .65). Patients who received geriatric consultation also did not have a reduction in emergency department visits (incidence rate ratio [IRR], 0.89; 95% CI, 0.33-2.42), hospitalization (IRR, 0.91; 95% CI, 0.30-2.71), or days spent in the hospital (IRR, 1.05; 95% CI, 0.29-3.79). However, investigators reported that geriatric consultation did improve the odds of having a discussion on end-of-life goals with patients (OR, 3.12; 95% CI, 1.03-9.41) and was found to be valued by hematologic oncologists who were surveyed.

A total of 270 patients enrolled on the trial, of whom 160 pre-frail or frail patients were randomly assigned to either the geriatric consultation and SOC group (n = 60) or the SOC alone group (n = 100). Patient characteristics were well balanced between arms; investigators noted high rates of functional impairment (35.6%), cognitive impairment (39.5%), and mobility impairment (60.6%).

Of those who received geriatric consultation, 80% (95% CI, 68%-88%) completed at least 1 visit with a geriatrician. Among the 12 patients who were assigned to receive consultation and did not, 3 died, 3 canceled, and 6 did not return for further care. For those who had at least 1 consultation (n = 48), 26 had 1 or more additional visits. Patients who enrolled towards the end of the study were more likely to have more total visits than those enrolled at the beginning of the trial.

Among the patients in the consultation arm who spoke with a geriatrician, the median number of recommended interventions was 2 per patient, the most common of which were comorbidity/polypharmacy domain (81.3%), nutrition (54.2%), function or falls (47.9%), cognition (31.3%), and depression or mood (16.7%). Of the recommended interventions, 97 were performed by the geriatrician through counseling, non-pharmacological recommendations, or pharmacological prescriptions. Additionally, 14 interventions were referrals or coordination with other disciplines; this included physical therapists, social workers, and nutritionists.

In the year following initial consultation, 32 patients died, including 11 in the consultation group vs 21 in the SOC group. Investigators did not find a significant association between the number of visits with a geriatrician and mortality (HR, 0.78; 95% CI, 0.43-1.39). Additionally, no difference was reported in terms of the effect of consultation on mortality among patients who were frail vs pre-frail (P = .41).

A survey of the perceived value of geriatric recommendations was given to oncologists, nurse practitioners, and physician assistants who had patients who had a geriatric consultation. Results from the surveys noted that clinicians found the consultations to be valuable in managing age-related domains of care. These included the evaluation of cognition, connecting patients to resources, diagnosing frailty, and managing non-oncologic comorbidities. The areas of management that were found to be most useful were optimizing functional status, treating falls, and treatment of depression and other mood disorders.

Reference

DuMontier C, Uno H, Hshieh T, et al. Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies. Haematologica. 2022;107(5):1172-1180. doi:10.3324/haematol.2021.278802