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    Original Investigation
    November 7, 2019

    Communication With Older Patients With Cancer Using Geriatric Assessment: A Cluster-Randomized Clinical Trial From the National Cancer Institute Community Oncology Research Program

    Author Affiliations
    • 1Department of Medicine, University of Rochester, Rochester, New York
    • 2University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program Research Base, Rochester, New York
    • 3Department of Family Medicine, University of Rochester, Rochester, New York
    • 4Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
    • 5Department of Surgery, University of Rochester, Rochester, New York
    • 6Stakeholders for Care in Oncology and Research for our Elders, Rochester, New York
    • 7Department of Health Behavior, Society, and Policy, Rutgers University School of Public Health, Piscataway, New Jersey
    • 8Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
    • 9University of Rochester School of Nursing, Rochester, New York
    • 10Novant Health Oncology Specialists, Winston-Salem, North Carolina
    • 11Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Winston-Salem, North Carolina
    • 12Heartland Cancer Research National Cancer Institute Community Oncology Research Program, Decatur, Illinois
    • 13Metro Minnesota Community Oncology Research Program, St Louis Park
    • 14Department of Medicine, University of Chicago, Chicago, Illinois
    • 15Department of Supportive Care, City of Hope National Medical Center, Duarte, California
    JAMA Oncol. Published online November 7, 2019. doi:https://doi.org/10.1001/jamaoncol.2019.4728
    Key Points

    Question  Does providing a summary of geriatric assessment results and geriatric assessment–guided recommendations to oncologists improve communication about aging-related concerns?

    Findings  In this nationwide cluster-randomized clinical trial of 31 community oncology practices that enrolled 541 older patients with advanced cancer, providing a geriatric assessment summary with recommendations to oncologists improved postvisit patient satisfaction and caregiver satisfaction and increased the number of conversations about aging-related concerns. These results were significantly different between the intervention and usual care groups.

    Meaning  Integrating geriatric assessment into community oncology care improves patient and caregiver satisfaction and communication about aging-related concerns.


    Importance  Older patients with cancer and their caregivers worry about the effects of cancer treatment on aging-related domains (eg, function and cognition). Quality conversations with oncologists about aging-related concerns could improve patient-centered outcomes. A geriatric assessment (GA) can capture evidence-based aging-related conditions associated with poor clinical outcomes (eg, toxic effects) for older patients with cancer.

    Objective  To determine whether providing a GA summary and GA-guided recommendations to oncologists can improve communication about aging-related concerns.

    Design, Setting, and Participants  This cluster-randomized clinical trial enrolled 541 participants from 31 community oncology practices within the University of Rochester National Cancer Institute Community Oncology Research Program from October 29, 2014, to April 28, 2017. Patients were aged 70 years or older with an advanced solid malignant tumor or lymphoma who had at least 1 impaired GA domain; patients chose 1 caregiver to participate. The primary outcome was assessed on an intent-to-treat basis.

    Interventions  Oncology practices were randomized to receive either a tailored GA summary with recommendations for each enrolled patient (intervention) or alerts only for patients meeting criteria for depression or cognitive impairment (usual care).

    Main Outcomes and Measures  The predetermined primary outcome was patient satisfaction with communication about aging-related concerns (modified Health Care Climate Questionnaire [score range, 0-28; higher scores indicate greater satisfaction]), measured after the first oncology visit after the GA. Secondary outcomes included the number of aging-related concerns discussed during the visit (from content analysis of audiorecordings), quality of life (measured with the Functional Assessment of Cancer Therapy scale for patients and the 12-Item Short Form Health Survey for caregivers), and caregiver satisfaction with communication about aging-related patient concerns.

    Results  A total of 541 eligible patients (264 women, 276 men, and 1 patient did not provide data; mean [SD] age, 76.6 [5.2] years) and 414 caregivers (310 women, 101 men, and 3 caregivers did not provide data; mean age, 66.5 [12.5] years) were enrolled. Patients in the intervention group were more satisfied after the visit with communication about aging-related concerns (difference in mean score, 1.09 points; 95% CI, 0.05-2.13 points; P = .04); satisfaction with communication about aging-related concerns remained higher in the intervention group over 6 months (difference in mean score, 1.10; 95% CI, 0.04-2.16; P = .04). There were more aging-related conversations in the intervention group’s visits (difference, 3.59; 95% CI, 2.22-4.95; P < .001). Caregivers in the intervention group were more satisfied with communication after the visit (difference, 1.05; 95% CI, 0.12-1.98; P = .03). Quality of life outcomes did not differ between groups.

    Conclusions and Relevance  Including GA in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns.

    Trial Registration  ClinicalTrials.gov identifier: NCT02107443