Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis

Mohammed Rashidul Anwar; Shant Torkom Yeretzian; Ana Patricia Ayala; Emma Matosyan; Henriette Breunis; Kathyrin Bote; Martine Puts; Mohammed Hassan Habib; Qixuan Li; Yeva Sahakyan; Shabbir M H Alibhai; Lusine Abrahamyan

doi:10.1093/jnci/djad200

Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis

J Natl Cancer Inst. 2023 Dec 6;115(12):1483-1496. doi: 10.1093/jnci/djad200.

Authors

Affiliations

¹ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
² Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia.
³ Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada.
⁴ University of Western Ontario, London, ON, Canada.
⁵ Department of Supportive Care, University Health Network, Toronto, ON, Canada.
⁶ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
⁷ Department of Medicine, University Health Network, Toronto, ON, Canada.
⁸ Biostatistics Research Unit, University Health Network, Toronto, ON, Canada.
⁹ Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.
¹⁰ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.

PMID: 37738290
DOI: 10.1093/jnci/djad200

Abstract

Background: Frailty and multimorbidity among older cancer patients affect treatment tolerance and efficacy. Comprehensive geriatric assessment and management is recommended to optimize cancer treatment, but its effect on various outcomes remains uncertain.

Objective: Our objective was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) and cost-effectiveness studies comparing comprehensive geriatric assessment (with or without implementation of recommendations) to usual care in older cancer patients.

Methods: We searched MEDLINE, EMBASE, CINAHL, and Cochrane trials from inception to January 27, 2023, for RCTs and cost-effectiveness studies. Pooled estimates for outcomes were calculated using random-effects models.

Results: A total of 19 full-text articles representing 17 RCTs were included. Average participant age was 72-80 years, and 31%-62% were female. Comprehensive geriatric assessment type, mode of delivery, and evaluated outcomes varied across studies. Meta-analysis revealed no difference in risk of mortality (risk ratio [RR] = 1.08. 95% confidence interval [CI] = 0.91 to 1.29), hospitalization (RR = 0.92, 95% CI = 0.77 to 1.10), early treatment discontinuation (RR = 0.89, 95% CI = 0.67 to 1.19), initial dose reduction (RR = 0.99, 95% CI = 0.99 to 1.26), and subsequent dose reduction (RR = 0.87, 95% CI = 0.70 to 1.09). However, the risk of treatment toxicity was statistically significantly lower in the comprehensive geriatric assessment group (RR = 0.78, 95% CI = 0.70 to 0.86). No cost-effectiveness studies were identified.

Conclusion: Compared with usual care, comprehensive geriatric assessment was not associated with a difference in risk of mortality, hospitalization, treatment discontinuation, and dose reduction but was associated with a lower risk of treatment toxicity indicating its potential to optimize cancer treatment in this population. Further research is needed to evaluate cost-effectiveness.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Female
Geriatric Assessment*
Hospitalization
Humans
Male
Neoplasms* / therapy
Outcome Assessment, Health Care

Abstract

Publication types

MeSH terms

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