Impact of Geriatric Assessment and Management on Quality of Life, Unplanned Hospitalizations, Toxicity, and Survival for Older Adults With Cancer: The Randomized 5C Trial.

Autor:	Puts M; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada., Alqurini N; Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait., Strohschein F; Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada., Koneru R; Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada., Szumacher E; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Mariano C; Department of Medical Oncology, BC Cancer Center, Vancouver, British Columbia, Canada., Monette J; Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada., Hsu T; Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada., Brennenstuhl S; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada., McLean B; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada., Wills A; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada., Berger A; Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada., Amir E; 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., Romanovsky L; Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada., Li A; Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada., Mehta R; Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Krzyzanowska M; Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Elser C; 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., Jang R; Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Prica A; Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Wan-Chow-Wah D; Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada., Pitters E; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada., Emmenegger U; Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Menjak IB; Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Bergman S; Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada., Lemonde M; Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada., Breunis H; Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Béland F; Public Health School, University of Montreal, Montreal, Quebec, Canada., Alibhai SMH; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2023 Feb 01; Vol. 41 (4), pp. 847-858. Date of Electronic Publication: 2022 Dec 06.
DOI:	10.1200/JCO.22.01007
Abstrakt:	Purpose: American Society of Clinical Oncology recommends that older adults with cancer being considered for chemotherapy receive geriatric assessment (GA) and management (GAM), but few randomized controlled trials have examined its impact on quality of life (QOL). Patients and Methods: The 5C study was a two-group parallel 1:1 single-blind multicenter randomized controlled trial of GAM for 6 months versus usual oncologic care. Eligible patients were age 70+ years, diagnosed with a solid tumor, lymphoma, or myeloma, referred for first-/second-line chemotherapy or immunotherapy or targeted therapy, and had an Eastern Cooperative Oncology Group performance status of 0-2. The primary outcome QOL was measured with the global health scale of the European Organisation for the Research and Treatment of Cancer QOL questionnaire and analyzed with a pattern mixture model using an intent-to-treat approach (at 6 and 12 months). Secondary outcomes included functional status, grade 3-5 treatment toxicity; health care use; satisfaction; cancer treatment plan modification; and overall survival. Results: From March 2018 to March 2020, 350 participants were enrolled. Mean age was 76 years and 40.3% were female. Fifty-four percent started treatment with palliative intent. Eighty-one (23.1%) patients died. GAM did not improve QOL (global QOL of 4.4 points [95% CI, 0.9 to 8.0] favoring the control arm). There was also no difference in survival, change in treatment plan, unplanned hospitalization/emergency department visits, and treatment toxicity between groups. Conclusion: GAM did not improve QOL. Most intervention group participants received GA on or after treatment initiation per patient request. Considering recent completed trials, GA may have benefit if completed before treatment selection. The COVID-19 pandemic may have affected our QOL outcome and intervention delivery for some participants.
Databáze:	MEDLINE
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