Page 167 - Haematologica May 2022

RCT of geriatric consultation in blood cancers
variable analyses (Table 2, Online Supplementary Tables S2 and S3). Moreover, there was no significant association between the number of visits with a geriatrician and mor- tality (hazard ratio = 0.78, 95% CI: 0.43 to 1.39), and there was no difference in the effect of consultation on mortality among frail versus pre-frail patients (test for interaction P=0.41). Frail patients experienced higher mortality, inde- pendently of intervention or other covariates (Online Supplementary Table S2).
Geriatric consultation and acute care utilization
Thirty-six of 160 patients (22.5%) experienced one or more unplanned hospitalizations during the first 6 months of follow-up, and the same number made one or more emergency department visits. In comparison with patients who received standard oncologic care, patients who received geriatric consultation did not have a significantly lower incidence of emergency department visits (incident rate ratio [IRR] = 0.89, 95% CI: 0.33 to 2.42), hospitaliza- tions (IRR = 0.91, 95% CI: 0.30 to 2.71), or days spent in
hospital (IRR = 1.05, 95% CI: 0.29 to 3.79), adjusting for covariates (Table 2). Per-protocol analyses yielded similar results.
Geriatric consultation and end-of-life goals-of-care dis- cussions
Seventeen of 160 patients (10.6%) received one or more EOL goals-of-care discussions during follow-up. In compar- ison with patients who received standard oncologic care, patients who received geriatric consultation had an over three-fold higher odds of a documented goals-of-care dis- cussion (odds ratio = 3.12, 95% CI: 1.03 to 9.41). Per-proto- col analyses yielded similar results (odds ratio = 3.58, 95% CI: 1.13 to 11.35). Three patients in each arm received a pal- liative care consultation.
Hematologic oncologists’ and other clinicians’ perceived value of geriatric consultation
Thirty-five of 65 (53.8%) hematologic oncologists, nurse practitioners, and physician assistants whose patients had
Figure 1. CONSORT flow diagram of trial enrollment and analysis. DFCI: Dana-Farber Cancer Institute; GA: geriatric assessment.
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