Implementing geriatric assessment and management for older Canadians with cancer: Adherence to and satisfaction with the intervention, results of the 5C study
Martine Puts 1, Jihad Abou Ali Waked 2, Fay Strohschein 3, Henriette Breunis 4, Naser Alqurini 5, Arielle Berger 6, Lindy Romanovsky 6, Johanne Monette 7, Rajin Mehta 8, Anson Li 9, Doreen Wan-Chow-Wah 7, Rama Koneru 10, Ewa Szumacher 11, Caroline Mariano 12, Tina Hsu 13, Sarah Brennenstuhl 2, Eitan Amir 14, Monika K Krzyzanowska 15, Raymond Jang 15, Eric Pitters 2, Urban Emmenegger 16, Ines B Menjak 16, Simon Bergman 17, Manon Lemonde 18, Francois Beland 19, Shabbir M H Alibhai 20
Affiliations
Affiliations
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. Electronic address: martine.puts@utoronto.ca.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
- Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
- Department of Geriatric Medicine, University Health Network, Ontario, Canada.
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
- Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada.
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
- Department of Medical Oncology, BC Cancer center, Vancouver, British Columbia, Canada.
- Division of Medical Oncology, the Ottawa Hospital, Ottawa, Ontario, Canada.
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
- Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
- Public Health School, University of Montreal, Montreal, Quebec, Canada.
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Abstract
Introduction: Geriatric assessment and management (GAM) is recommended by professional organizations and recently several randomized controlled trials (RCTs) demonstrated benefits in multiple health outcomes. GAM typically leads to one or more recommendations for the older adult on how to optimize their health. However, little is known about how well recommendations are adhered to. Understanding these issues is vital to designing GAM trials and clinical programs. Therefore, the aim of this study was to examine the number of GAM recommendations made and adherence to and satisfaction with the intervention in a multicentre RCT of GAM for older adults with cancer.
Materials and methods: The 5C study was a two-group parallel RCT conducted in eight hospitals across Canada. Each centre kept a detailed recruitment and retention log. The intervention teams documented adherence to their recommendations. Medical records were also reviewed to assess which recommendations were adhered to. Twenty-three semi-structured interviews were conducted with 12 members of the intervention teams and 11 oncology team members to assess implementation of the study and the intervention.
Results: Of the 350 participants who were enrolled, 173 were randomized to the intervention arm. Median number of recommendations was seven. Mean adherence to recommendations based on the GAM was 69%, but it varied by type of recommendation, ranging from 98% for laboratory tests to 28% for psychosocial/psychiatry oncology referrals. There was no difference in the number of recommendations or non-adherence to recommendations by sex, level of frailty, or functional status. Oncologists and intervention team members were satisfied with the study implementation and intervention delivery.
Discussion: Adherence to recommendations was variable. Adherence to laboratory investigations and further imaging were generally high but much lower for recommendations regarding psychosocial support. Further collaborative work with older adults with cancer is needed to understand how to optimize the intervention to be consistent with patient goals, priorities, and values to ensure maximal impact on health outcomes.
Keywords: Aged; Cancer treatment; Comprehensive geriatric assessment; Process evaluation; Qualitative study; Randomized controlled trial.
Conflict of interest statement
Declaration of Competing Interest Dr. Tina Hsu received financial support from Pfizer, Mylan and Knight Therapeutics for advisory board not related to this study. Dr. Eitan Amir received financial support from Novartis not related to this study. Dr. Emmenegger reports personal fees from Amgen, grants and personal fees from Astellas, grants and personal fees from AstraZeneca, grants and personal fees from Bayer, grants from Clovis, personal fees from Ferring, grants and personal fees from Janssen, personal fees from Knight, grants and personal fees from Merck, grants and personal fees from Novartis, personal fees from Pfizer, grants from Roche Genentech, outside the submitted work.