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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)1435-1444
Number of pages10
JournalBJC: British Journal of Cancer
Volume112
Issue number9
Early online date14 Apr 2015
DOIs
Accepted/In press11 Mar 2015
E-pub ahead of print14 Apr 2015
Published28 Apr 2015

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King's Authors

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.

Keywords: comprehensive geriatric assessment; elderly; geriatric oncology; chemotherapy tolerance; toxicity; interventions

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