Implementing geriatric assessment and management for older Canadians with cancer: Adherence to and satisfaction with the intervention, results of the 5C study

Martine Puts; Jihad Abou Ali Waked; Fay Strohschein; Henriette Breunis; Naser Alqurini; Arielle Berger; Lindy Romanovsky; Johanne Monette; Rajin Mehta; Anson Li; Doreen Wan-Chow-Wah; Rama Koneru; Ewa Szumacher; Caroline Mariano; Tina Hsu; Sarah Brennenstuhl; Eitan Amir; Monika K Krzyzanowska; Raymond Jang; Eric Pitters; Urban Emmenegger; Ines B Menjak; Simon Bergman; Manon Lemonde; Francois Beland; Shabbir M H Alibhai

doi:10.1016/j.jgo.2023.101586

Implementing geriatric assessment and management for older Canadians with cancer: Adherence to and satisfaction with the intervention, results of the 5C study

J Geriatr Oncol. 2023 Sep;14(7):101586. doi: 10.1016/j.jgo.2023.101586. Epub 2023 Jul 15.

Authors

Martine Puts¹, Jihad Abou Ali Waked², Fay Strohschein³, Henriette Breunis⁴, Naser Alqurini⁵, Arielle Berger⁶, Lindy Romanovsky⁶, Johanne Monette⁷, Rajin Mehta⁸, Anson Li⁹, Doreen Wan-Chow-Wah⁷, Rama Koneru¹⁰, Ewa Szumacher¹¹, Caroline Mariano¹², Tina Hsu¹³, Sarah Brennenstuhl², Eitan Amir¹⁴, Monika K Krzyzanowska¹⁵, Raymond Jang¹⁵, Eric Pitters², Urban Emmenegger¹⁶, Ines B Menjak¹⁶, Simon Bergman¹⁷, Manon Lemonde¹⁸, Francois Beland¹⁹, Shabbir M H Alibhai²⁰

Affiliations

¹ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. Electronic address: martine.puts@utoronto.ca.
² Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
³ Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
⁵ Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
⁶ Department of Geriatric Medicine, University Health Network, Ontario, Canada.
⁷ Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
⁸ Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁹ Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
¹⁰ Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada.
¹¹ Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹² Department of Medical Oncology, BC Cancer center, Vancouver, British Columbia, Canada.
¹³ Division of Medical Oncology, the Ottawa Hospital, Ottawa, Ontario, Canada.
¹⁴ 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.
¹⁵ Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
¹⁶ Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹⁷ Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
¹⁸ Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
¹⁹ Public Health School, University of Montreal, Montreal, Quebec, Canada.
²⁰ Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada.

PMID: 37459767
DOI: 10.1016/j.jgo.2023.101586

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Canada
Frailty*
Geriatric Assessment
Humans
Neoplasms* / therapy
Personal Satisfaction
Randomized Controlled Trials as Topic