Format

Send to

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

The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.

Author information

1
1] Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.
2
Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
3
Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
4
Department of Clinical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
5
Department of Haematology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
6
Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.

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.

PMID:
25871332
PMCID:
PMC4453673
DOI:
10.1038/bjc.2015.120
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Nature Publishing Group Icon for PubMed Central
Loading ...
Support Center