The Impact of Comprehensive Geriatric Assessment Interventions on Tolerance to Chemotherapy in Older People

Br J Cancer. 2015 Apr 28;112(9):1435-44. doi: 10.1038/bjc.2015.120. Epub 2015 Apr 14.

Abstract

Background: Although comorbidities are identified in routine oncology practice, intervention plans for the coexisting needs of older people receiving chemotherapy are rarely made. This study evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer.

Methods: Comparative study of two cohorts of older patients (aged 70+ years) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010-July 2012) received standard oncology care. The intervention group (N=65, September 2011-February 2013) underwent risk stratification using a patient-completed screening questionnaire and high-risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions.

Results: Intervention participants undergoing CGA received mean of 6.2±2.6 (range 0-15) CGA intervention plans each. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI: 1.50-11.42), P=0.006) and fewer required treatment modifications (OR 0.34 (95% CI: 0.16-0.73), P=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group and 52.9% in the control (P=0.292).

Conclusions: Geriatrician-led CGA interventions were associated with improved chemotherapy tolerance. Standard oncology care should shift towards modifying coexisting conditions to optimise chemotherapy outcomes for older people.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Case-Control Studies
  • Comorbidity
  • Drug Tolerance
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Female
  • Follow-Up Studies
  • Geriatric Assessment*
  • Humans
  • London / epidemiology
  • Male
  • Neoplasm Metastasis
  • Neoplasms / drug therapy*
  • Neoplasms / rehabilitation*
  • Patient Care Planning
  • Prognosis
  • Prospective Studies