Comprehensive geriatric assessment: Valuation and patient preferences in older Japanese adults with cancer

Tomohiro F Nishijima; Mototsugu Shimokawa; Taito Esaki; Masaru Morita; Yasushi Toh; Hyman B Muss

doi:10.1111/jgs.18023

Comprehensive geriatric assessment: Valuation and patient preferences in older Japanese adults with cancer

J Am Geriatr Soc. 2023 Jan;71(1):259-267. doi: 10.1111/jgs.18023. Epub 2022 Sep 16.

Authors

Tomohiro F Nishijima^{1

2

3}, Mototsugu Shimokawa^{4

5}, Taito Esaki², Masaru Morita⁶, Yasushi Toh⁶, Hyman B Muss³

Affiliations

¹ Geriatric Oncology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
² Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
³ Department of Medicine, Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁴ Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
⁵ Cancer Biostatistics Laboratory, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
⁶ Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.

PMID: 36112729
DOI: 10.1111/jgs.18023

Abstract

Background: Current guidelines recommend a comprehensive geriatric assessment (CGA) for the management of older adults with cancer. We evaluated the effect of CGA conducted by a geriatric oncology service (GOS) on the management of older adults with cancer. We also queried patients about their perceptions of the value of this process.

Methods: This was a prospective quality assessment study of 498 consecutive older adults with cancer who were referred to the GOS from May 2020 through December 2021. Treating physicians requested a consultation and the GOS conducted a CGA and assessed patient preferences. The GOS provided recommendations on cancer treatment and geriatric interventions. Patient perspectives on the consultation were evaluated using collaboRATE and modified Patient Assessment of Care for Chronic Conditions (PACIC) subscales.

Results: A 10-item frailty index based on a CGA (FI-CGA-10) [Oncologist, 26, e1751 (2021)] in the 498 patients showed that 19% of patients were fit, 40% pre-frail, and 41% frail. Prior to CGA the intent of the proposed cancer treatment was curative in 56% (n = 280), life-extending in 40% (n = 201), and palliative in 3.4% (n = 17). After a CGA consultation, a cancer treatment decision was changed in 45% of patients. The intent of treatment after the CGA consultation was curative in 45%, life-extending in 34%, and palliative in 21%. At least one referral to relevant disciplines was recommended for 88% of patients and was implemented in 43%. As part of the GOS consultation educational support was provided to 97% of patients. Based on the collaboRATE and PACIC tools, patients perceived the GOS consultation positively and helpful for facilitating shared decision-making and patient-centered care.

Conclusion: Our institutional experience demonstrated the valuable effect of the CGA consultation on oncologic decision-making and geriatric interventions in a patient-centered manner.

Keywords: comprehensive geriatric assessment; geriatric oncology service; older adults with cancer; patient-centered care; treatment decision.

MeSH terms

Aged
East Asian People*
Geriatric Assessment
Humans
Medical Oncology
Neoplasms* / therapy
Patient Preference
Prospective Studies

Grants and funding

20K16540/Japan Society for the Promotion of Science