Page 164 - Haematologica May 2022

Ferrata Storti Foundation
Haematologica 2022 Volume 107(5):1172-1180
Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies
Clark DuMontier,1,2,3 Hajime Uno,3,4 Tammy Hshieh,1,3,5 Guohai Zhou,1,3 Richard Chen,5 Emily S. Magnavita,5 Lee Mozessohn,6 Houman Javedan,1,3 Richard M. Stone,3,5 Robert J. Soiffer,3,5 Jane A. Driver1,2,3# and Gregory A. Abel3,5#
1Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA; 2New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; 3Harvard Medical School, Boston, MA, USA; 4Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; 5Department of Medical Oncology, Dana- Farber Cancer Institute, Boston, MA, USA and 6Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
#JAD and GAA contributed equally as co-senior authors.
ABSTRACT
We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatri- cian consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients aged ≥75 years who presented for initial consultation for lym- phoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA, USA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficit-accumulation approaches, were random- ized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end-of-life (EOL) goals-of-care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consulta- tion plus standard care (n=60) or standard care alone (n=100). The median age of the patients was 80.4 years (standard deviation = 4.2). Of those ran- domized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at 1 year com- pared to standard care (difference: 2.9%, 95% confidence interval: -9.5% to 15.2%, P=0.65), and did not significantly reduce the incidence of emer- gency department visits, hospital admissions, or days in hospital. Consultation did improve the odds of having EOL goals-of-care discus- sions (odds ratio = 3.12, 95% confidence interval: 1.03 to 9.41) and was valued by surveyed hematologic-oncology clinicians, with 62.9%-88.2% of them rating consultation as useful in the management of several geri- atric domains.
Introduction
Older adults constitute the majority of patients with hematologic malignancies, as the median ages at diagnosis of non-Hodgkin lymphoma, leukemia, and multiple myeloma are 67, 67, and 69 years, respectively.1-3 Compared with younger patients, older patients with blood cancers often have age-related vulnerabilities that compli- cate their care.4 Cognitive impairment, functional dependency, and frailty are preva- lent and associated with worse outcomes such as increased treatment toxicity, unplanned hospitalizations, and higher mortality.5-7 To manage this complexity, can- cer organizations such as the American Society of Clinical Oncology (ASCO) recom- mend that all older adults with cancer treated with chemotherapy undergo a geriatric assessment (GA): a multidisciplinary evaluation of domains necessary for older adult health and well-being.8
Quality of Life
Correspondence:
GREGORY A. ABEL
gregory_abel@dfci.harvard.edu
Received: March 18, 2021. Accepted: September 3, 2021. Pre-published: September 23, 2021.
https://doi.org/10.3324/haematol.2021.278802 ©2022 Ferrata Storti Foundation
Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or inter- nal use. Sharing published material for non-commercial pur- poses is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for com- mercial purposes is not allowed without permission in writing from the publisher.
1172
haematologica | 2022; 107(5)
ARTICLE