Evaluating the association of frailty with communication about aging-related concerns between older patients with advanced cancer and their oncologists

Nikesha Gilmore, Huiwen Xu, Lee Kehoe, Amber S. Kleckner, Kiran Moorthi, Lianlian Lei, Mostafa R.S. Mohamed, Kah Poh Loh, Eva Culakova, Marie Flannery, Erika Ramsdale, Paul R. Duberstein, Beverly Canin, Charles Kamen, Gilbert Giri, Erin Watson, Amita Patil, Adedayo A. Onitilo, Brian Burnette, Michelle JanelsinsSupriya G. Mohile

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown. Methods: This was a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and impairment on 1 or more GA domains (ClinicalTrials.gov Identifier NCT02107443; principal investigator Supriya G. Mohile). Practice sites were randomized to either the GA-intervention or usual care. Frailty was assessed with a deficit accumulation index (range, 0-1), and patients were stratified as robust (0 to <0.2), prefrail (0.2 to <0.35), or frail (≥0.35). The clinic visit after the GA-intervention was audio-recorded, transcribed, and coded to evaluate the number and quality of conversations about aging-related concerns. Linear mixed models examined differences in the number and quality of conversations within and between arms. All P values were 2-sided. Results: Patients (n = 541) were classified as robust (27%), prefrail (42%), or frail (31%). In the usual care arm, frail patients (vs robust ones) engaged in more aging-related conversations (adjusted mean difference, 1.73; 95% confidence interval [CI], 0.59-2.87), conversations of higher quality (difference, 1.12; 95% CI, 0.24-2.0), and more discussions about evidence-based recommendations (difference, 0.71; 95% CI, 0.04-1.38; all P values ≤.01). Similarly, in the GA intervention arm, frail patients (vs robust ones) engaged in more aging-related conversations (difference, 2.49; 95% CI, 1.51-3.47), conversations of higher quality (difference, 1.31; 95% CI, 0.56-2.06), and more discussions about evidence-based recommendations (difference, 0.87; 95% CI, 0.32-1.42; all P values ≤.01). Furthermore, the GA-intervention significantly improved the number and quality of conversations in all patients: robust, prefrail, and frail (all P values ≤.01). Conclusions: Patients with higher degrees of frailty and those exposed to the GA-intervention had more and higher quality conversations about aging-related concerns with oncologists. Lay Summary: A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown. This study conducted a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and 1 or more GA domain impairments. Patients were stratified as robust, prefrail, or frail. The number and quality of conversations about aging-related concerns that occurred during the clinic visit after the GA-intervention were determined. Patients with higher degrees of frailty and those in the GA intervention arm had more and higher quality conversations about aging-related concerns with oncologists.

Original languageEnglish (US)
Pages (from-to)1101-1109
Number of pages9
JournalCancer
Volume128
Issue number5
DOIs
StatePublished - Mar 1 2022
Externally publishedYes

Keywords

  • communication
  • frailty
  • geriatric assessment
  • older adults with cancer
  • satisfaction with communication

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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