Geriatric Assessment Improves Patient Satisfaction, Patient-Oncologist Communication

Supriya Gupta Mohile, MD, MS

Evaluating health-related concerns as part of routine care for elderly patients with advanced cancer significantly improved doctor-patient communication and patient satisfaction, according to results discussed in a press conference Friday at the 2018 ASCO Annual Meeting.¹

Overall, the mean number of patient-oncologist discussions was 6.3. Patients whose physicians conducted geriatric assessment had a mean of 3.5 more discussions about age-related concerns than patients whose physicians did not (7.74 vs 4.24; 95% CI, 2.28-4.72, P <.0001).

In the geriatric assessment group, patient satisfaction with communication was a statistically significant 1.12 points higher than in the control group (95% CI, 0.23-2.03; P = .027). Lead author Supriya Gupta Mohile, MD, MS, the Wehrheim Professor of Medicine at the University of Rochester, said the differences in satisfaction scores persisted for up to 3 months.

“A web-based geriatric assessment summary with recommendations for interventions improved patient-centered outcomes, including direct communication about age-related health concerns and patient satisfaction with communication,” she said.

Adults aged ≥70 years represent the fastest growing patient population in cancer. These patients often want treatment, Mohile said, but only if it does not have a negative effect on other health issues.

“Physicians often don’t know patients’ and caregivers’ age-related health concerns, such as concerns about memory or concerns about falling,” she said. “Many patients and caregivers do not ask about age-related concerns because of their unclear understanding of the relevance of those issues to an oncology clinical encounter.”

Geriatric assessment is an evaluation of the age-related domains about physical and mental health, nutrition, and social support known to predict morbidity and mortality in older patients. Despite its benefits, Mohile said only 20% of community oncology practices use geriatric assessment.

Mohile was the lead author on an ASCO Clinical Practice Guideline released in May that recommended geriatric assessment for all patients aged ≥65 years undergoing chemotherapy. Based on a review of 68 studies, ASCO concluded that these patients should be assessed for cognition, comorbidity, depression, falls, function, and nutrition.²

In this study, eligible patients were aged ≥70 years, diagnosed with incurable, advanced solid tumors or lymphoma, and treated at 31 community oncology practices affiliated with the University of Rochester’s NCI Community Oncology Research Program. A total of 530 patients were evaluable for outcomes.

The mean patient age was 77 years and women made up 49% of the cohort. All patients had at least 1 impairment for function, physical performance, comorbidities, nutrition, social support, depression, or cognition. More than 90% of patients had physical impairments, 33.2% had impaired cognition, and 25.1% had psychological impairments, primarily depression.

Patients were assigned to geriatric assessment (n = 295) or usual care (n = 247). All patients underwent geriatric assessment, but only oncologists in the experimental arm received the patient summary and suggested interventions.

Office staff scored the tests and entered the results into the Cancer and Aging Research Group website. The site then provided the oncologist with a patient summary and a list of interventions.

Number of discussions about age-related concerns and patient satisfaction as measured by the modified Health Care Climate Questionnaire were the primary outcomes.

On average, patients in the geriatric assessment arm had 2.0 more high-quality doctor-patient conversations than in the usual care arm (4.42 vs 2.47; 95% CI, 1.20-2.69; P <.0001). Physicians in the experiential arm were also more likely to order interventions such as physical therapy for these patients (3.08 vs 1.15; 95% CI: 1.14-2.73; P <.0001).

Patients in the geriatric assessment arm were less likely to experience impaired physical performance (96% vs 92%, P = .03) or social support (33% vs 25%, P = .05).

Mohile added that data on secondary outcomes is not yet mature, and that studies in the United States and Europe assessing outcomes including function, quality of life, and caregiver satisfaction are ongoing.

ASCO expert Joshua A. Jones, MD, MA, assistant professor of clinical radiation oncology at the University of Pennsylvania’s Perelman School of Medicine, said these results were likely to have a direct impact on the care of older patients.

“We can, with a simple intervention, improve communication about what’s really important to older patients with cancer,” he said. “We have interventions; things like physical therapy, things like counseling, supports that can be provided to patients and families as they’re thinking through treatment decisions, helping us to provide the most appropriate care for these individuals. With a simple validated assessment, we can make sure that we are understanding what is most important to our patients and providing the right kind of care that they want.”

References

1. Mohile SG, Epstein RM, Hurria A, et al. Improving communication with older patients with cancer using geriatric assessment (GA): A University of Rochester NCI Community Oncology Research Program (NCORP) cluster randomized controlled trial (CRCT). J Clin Oncol. 2018;36 (suppl; abstr LBA10003).
2. Mohile SG, Dale W, Somerfield MR, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy [published online May 21, 2018]. J Clin Oncol. doi: 10.1200/JCO.2018.78.8687.

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