PURPOSE Older patients with advanced cancer often have comorbidities that can worsen their cancer and treatment outcomes. We assessed how a geriatric assessment (GA)–guided intervention can guide conversations about comorbidities among patients, oncologists, and caregivers. METHODS This secondary analysis arose from a nationwide, multisite cluster-randomized trial (ClinicalTrials.gov identifier: NCT02107443). Eligible patients were $ 70 years, had advanced cancer (solid tumors or lymphoma), and had impairment in at least one GA domain (not including polypharmacy). Oncology practices (n 5 30) were randomly assigned to usual care or intervention. All patients completed a GA; in the intervention arm, a GA summary with recommendations was provided to their oncologist. Patients completed an Older Americans Resources and Services Comorbidity questionnaire at screening. The clinical encounter following GA was audio-recorded, transcribed, and coded for topics related to comorbidities. Linear mixed models examined the effect of the intervention on the outcomes adjusting for practice site as a random effect. RESULTS Patients (N 5 541) were 76.6 6 5.2 years old; 94.6% of patients had at least one comorbidity with an average of 3.2 6 1.9. The intervention increased the average number of conversations regarding comorbidities per patient from 0.52 to 0.99 (P, .01). Moreover, there were a greater number of concerns acknowledged (0.52 v 0.32; P 5 .03) and there was a 2.4-times higher odds of having comorbidity concerns addressed via referral, handout, or other modes (95% CI, 1.3 to 4.3; P 5 .004). Most oncologists in the intervention arm (76%) discussed comorbidities in light of the treatment plan, and 41% tailored treatment plans. CONCLUSION Providing oncologists with a GA-guided intervention enhanced communication regarding comorbidities.
|Original language||English (US)|
|Journal||JCO Oncology Practice|
|State||Published - Jan 1 2022|
ASJC Scopus subject areas
- Health Policy