- Email: [email protected]
A feasibility trial of geriatric assessment and management for older cancer patients
Abstracts
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(P b 0.001), time to first geriatric visit postoperatively (P b 0.001), higher estimated blood loss at surgery (P = 0.011), longer operation time (P b 0.001), and longer length of stay (P = 0.003). On multivariate analysis older age (OR 1.666, P = 0.001), unmarried status (OR 1.355, P = 0.042), weight loss N10 lbs over the previous 6 months (OR 1.384, P = 0.030), preoperative ADL dependency (OR 2.086, P b 0.001), longer operation time (OR 1.004, P b 0.001), longer length of stay (OR 1.039, P = 0.007) and postoperative delirium (OR 2.545, P b 0.001) were independently associated with utilization of skilled services. Conclusion: Utilization of skilled services at discharge after surgery in elderly cancer patients is associated with a number of variables encompassing both patient characteristics and the hospitalization. Addressing the modifiable variables by optimizing preoperative functional and nutritional status, implementing protocols to prevent delirium and streamlining the hospital stay may impact the discharge disposition and may help control healthcare costs and achieve a better outcome for the older cancer patient. References: 1. Mechanic R. Post-Acute Care — The Next Frontier for Controlling Medicare Spending. 2014. 2. Devon KM, Urbach DR, McLeod RS. Postoperative disposition and health services use in elderly patients undergoing colorectal cancer surgery: a population-based study. Surgery. 2011;149(5): 705–12. 3. Aghazadeh MA, Barocas DA, Salem S, Clark PE, Cookson MS, Davis R, et al. Determining factors for hospital discharge status after radical cystectomy in a large contemporary cohort. The Journal of urology. 2011;185(1):85–9. Disclosure of Interest: None declared
Keywords: Clinical trials, Communication
Keyword: Economics
doi:10.1016/j.jgo.2014.09.078
oncologist. Standard care was defined by the National Cancer Institute as, “proper treatment for a certain type of disease and that is widely used by healthcare professionals,” and was considered treatment adherent to National Comprehensive Cancer Network guidelines. Nonstandard care was defined as deviation from accepted guidelines. Univariate analyses were performed to identify factors associated with completely adherent or less than completely adherent treatment plans. Results: Standard treatment Non-standard treatment Total N (%) N (%) Stage Stage Stage Stage
0-I, IVECOG active 0-I, IVECOG limited II-IIIECOG active II-IIIECOG limited
9 (90) 15 (93.8) 7 (87.5) 5 (41.7)
1 (10) 1 (6.3) 1 (12.5) 7 (58.3)
10 16 8 12
Of the n = 52 SAO patients analyzed, 77% received standard care, i.e., care completely adherent to guidelines. Stage II and III patients were significantly more likely than stage 0–1 and IV patients to receive non-standard care (RR = 6.3; 95% CI: 1.5 – 26.0). Patients with curable disease tended to receive non-standard care more often than those with non-curable disease (RR = 2.6; 95% CI: 0.7 – 10.8). Among the curable patients, those with functional limitations tended to receive non-standard care more often than the fully active (RR = 6.6; 95% CI: 0.9 – 47.2). Conclusion: These findings may indicate that functional status is more significant than curability in treatment planning for SAO patients. Disclosure of Interest: None declared.
doi:10.1016/j.jgo.2014.09.077 Geriatric Assessment Geriatric Assessment P049 ADHERENCE TO GUIDELINES IN SENIOR ADULT ONCOLOGY PATIENTS: IS STANDARD CARE THE RIGHT CARE? A. Mackenzie1, L.D.O. Koch2, T. Wolf3, J. Cocroft3, S.W. Keith4, J. Schoppe1, A. Barsevick3, R. Myers3, A. Chapman1 1 Oncology, Thomas Jefferson University Hospital, Philadelphia, United States 2 Hospital Israelita Albert Einstein, Sao Paolo, Brazil 3 Population Science, United States 4 Graduate School of Biomedical Sciences, Thomas Jefferson University Hospital, Philadelphia, United States Introduction: Over 50% of new cancer diagnoses occur in senior adult oncology (SAO) patients (≥65 years of age). However, as SAO patients may not be treated with standard care, it is important to assess treatment patterns among SAO patients. Objectives: The objectives of this retrospective review were to: (1) Determine whether senior adult oncology patients seen in a hospitalbased oncology practice received care adherent to or less than adherent to national guidelines, and (2) identify factors that influenced those patterns of care. Methods: The research team performed a retrospective analysis of demographic and clinical predictors of standard versus non-standard care for SAO patients with a potentially curable malignancy. “Patterns of care” was defined by the authors as the treatment plans (including surgery and/or systemic treatment and/or radiation) designed by the treating
P051 A FEASIBILITY TRIAL OF GERIATRIC ASSESSMENT AND MANAGEMENT FOR OLDER CANCER PATIENTS M. Puts1,⁎, M. Krzyzanowska2, E. Amir2, A. Joshua2, J. Monette3, D. Wan-Chow-Wah3, R. Jang2, S. Alibhai4 1 Nursing, University of Toronto, Canada 2 Medical Oncology, Princess Margaret Cancer Centre University Health Network, Toronto, Canada 3 Geriatric Medicine, Jewish General Hospital, Montreal, Canada 4 Medicine, University Health Network, Toronto, Canada
Introduction: The majority of persons diagnosed with cancer are older adults. Treatment decision-making for older adults can be difficult as they often have other diseases and/or functional limitations. The aim of comprehensive geriatric assessment (CGA) in an older population is to identify current health care problems and start interventions to prevent/postpone adverse outcomes and to maintain/improve the functional status and well-being of older adults. A CGA followed by an integrated care plan might help the cancer treatment team better tailor treatment to their older patient and have a positive impact on health and well-being, but there is limited and conflicting evidence to support the effectiveness of CGA in the oncology setting and no randomized controlled trial (RCT) has been completed in this setting. Objectives: What is the efficacy of CGA followed by an integrated care plan in optimizing outcomes in the elderly with advanced breast or gastrointestinal (GI) or genitourinary (GU) cancer?
S48
Abstracts
Methods: We will use a two-group parallel single-blind phase II RCT. The inclusion criteria are: aged 70 years and over, diagnosed with GI, GU or breast cancer, referred for first line chemotherapy or received b2 cycles and b6 weeks after start of chemotherapy at the Princess Margaret Cancer Centre who are able to speak English, have a physician-estimated life expectancy N6 months, ECOG PS 0-2 and able to give informed consent. Randomization to intervention (GA followed by integrated care plan) and control group (usual care by oncologist) will be 1:1 using opaque sealed envelopes and stratified based on treatment intent (adjuvant vs. palliative). Sample size: 60 participants (30 per study arm). The planned intervention includes a full CGA by a multidisciplinary geriatric team followed by an integrated care plan to address the issues identified. The CGA will include the following domains based on guidelines and expert recommendations: 1) Functional status; 2) Medication review; 3) Cognitive assessment; 4) Nutritional status; 5) Comorbidities; 6) Psychological functioning; 7) Social support. Based on this CGA and discussion with the patient, tailored evidence-based interventions will be carried out by the multidisciplinary geriatric team using a standardized intervention protocol. Participants in the intervention group will be seen by the intervention team at baseline for the CGA and development of the integrated care plan; and 2) at 3 months to assess intervention fidelity and measure outcomes. The co-primary outcomes are: 1) Quality of life (EORTC QLQ-C30); 2) Modification of the cancer treatment plan. The secondary outcomes are 1) Functional status (OARS Instrumental Activities of Daily Living); and 2) feasibility of the study by tumour site. Results: preliminary data will be presented at the SIOG meeting. Conclusion: This will be one of the first RCTs of CGA in geriatric oncology to show feasibility and obtain preliminary efficacy estimates to prepare a phase 3 trial. Disclosure of Interest: None declared Keywords: Breast cancer, Clinical trials, Colorectal, Epidemiology doi:10.1016/j.jgo.2014.09.080
Geriatric Assessment P052 ACCURATE CLASSIFICATION OF PERFORMANCE STATUS IN ELDERLY PATIENTS: DESIGN, VALIDATION AND IMPLEMENTATION OF A REMOTE PATIENT ACTIVITY MONITORING DEVICE A. Naeim1,⁎, K.M. Vander Wall1, J. Lucier1, M. Sarrafzadeh2, H.-J.R. Tan3, B. Mortazavi2, E. Nemati2 1 Hematology/Oncology, United States 2 Computer Science, United States 3 Urology, UCLA Medical Center, Los Angeles, United States
Objectives: (1) Evaluate how well pre-operative, pre-transplant and pre-trial cancer patients are able to tolerate and interact with a wireless SmartWatch device (including user-friendliness of the designed software). (2) Determine if activity and quality of life data collected continuously and in real-time by the SmartWatch device demonstrates a different level of pre-operative fitness than a standard onetime clinical assessment. (3) Review the correlation between functional status determined by the SmartWatch device and postoperative complications, length of stay, postoperative re-admissions, and discharge requirements. Methods: This pilot study will recruit 120 cancer patients aged 65 and older prior to planned cancer surgery, stem cell transplant or early-phase clinical trial enrollment. Consent will occur within 4– 6 weeks of planned procedure. At baseline/consent each subject will undergo a comprehensive geriatric assessment, a timed and videotaped “get up and go” test, and multiple validated short form surveys addressing nutritional status, sleep, pain, frailty, cognition, activities of daily living, instrumental activities of daily living, social support, and depression/anxiety. Each subject begins wearing the SmartWatch device at the time of the baseline visit, and it begins to collect data continuously. After completion of the baseline assessment, each subject wears the watch home and then wears the device continuously for a 7-day period. Activity data is collected at a frequency of 10 hz and the same surveys collected at baseline are delivered in a novel dynamic approach electronically to each watch device over the course of the 7-day period. The watch is then returned prior to surgery, clinical trial consent or transplant. Results: This pilot study is currently underway. Interim analysis will be available as late-breaking material prior to the scheduled conference. The analysis will focus on the following: (1) Comparison of one-time geriatric assessment against continuous remote sensing and dynamic questionnaire administration, (2) Usability and Patient Perception and Satisfaction with wearing and interacting with the SmartWatch, (3) Potential cut-off points and ROC curves for performance screening using sensing technology, (4) a summary of methodological issues associated with incorporating novel technology in trials with older cancer patients. Conclusion: We have designed and validated a tool that allows for continuous, passive collection of important performance, functional status, nutritional, cognitive and pain score data. The data generated can provide a meaningful assessment of performance and functional status that is collected in an efficient manner without taking significant time in a busy oncology practice. Disclosure of Interest: None declared. Keywords: Clinical trials, Epidemiology, Translational research doi:10.1016/j.jgo.2014.09.081
Introduction: Recent advances in technology allow for the possibility of more dynamic assessment and monitoring of patients. Within the past 6–12 months, “intelligent” easy to wear electronic devices have been brought to market that are able to collect and transmit various types of biodata—patient position, time in motion, and even responses to questionnaires delivered in a dynamic fashion remotely. These devices may also be able to detect heart rate, blood pressure, temperature and other bio-parameters. These remote sensors will play a critical role in assessing and monitoring vulnerable or frail patient populations at risk of repeated health complications.
Geriatric Assessment P053 DEVELOPMENT AND VALIDATION OF THE DELIRIUM RISK ASSESSMENT SCORE (DRAS) R. Vreeswijk1,⁎, K. Kalisvaart1, I. Kalisvaart2 1 Geriatrics 2 Kennemer Gasthuis, Haarlem, Netherlands
S47
(P b 0.001), time to first geriatric visit postoperatively (P b 0.001), higher estimated blood loss at surgery (P = 0.011), longer operation time (P b 0.001), and longer length of stay (P = 0.003). On multivariate analysis older age (OR 1.666, P = 0.001), unmarried status (OR 1.355, P = 0.042), weight loss N10 lbs over the previous 6 months (OR 1.384, P = 0.030), preoperative ADL dependency (OR 2.086, P b 0.001), longer operation time (OR 1.004, P b 0.001), longer length of stay (OR 1.039, P = 0.007) and postoperative delirium (OR 2.545, P b 0.001) were independently associated with utilization of skilled services. Conclusion: Utilization of skilled services at discharge after surgery in elderly cancer patients is associated with a number of variables encompassing both patient characteristics and the hospitalization. Addressing the modifiable variables by optimizing preoperative functional and nutritional status, implementing protocols to prevent delirium and streamlining the hospital stay may impact the discharge disposition and may help control healthcare costs and achieve a better outcome for the older cancer patient. References: 1. Mechanic R. Post-Acute Care — The Next Frontier for Controlling Medicare Spending. 2014. 2. Devon KM, Urbach DR, McLeod RS. Postoperative disposition and health services use in elderly patients undergoing colorectal cancer surgery: a population-based study. Surgery. 2011;149(5): 705–12. 3. Aghazadeh MA, Barocas DA, Salem S, Clark PE, Cookson MS, Davis R, et al. Determining factors for hospital discharge status after radical cystectomy in a large contemporary cohort. The Journal of urology. 2011;185(1):85–9. Disclosure of Interest: None declared
Keywords: Clinical trials, Communication
Keyword: Economics
doi:10.1016/j.jgo.2014.09.078
oncologist. Standard care was defined by the National Cancer Institute as, “proper treatment for a certain type of disease and that is widely used by healthcare professionals,” and was considered treatment adherent to National Comprehensive Cancer Network guidelines. Nonstandard care was defined as deviation from accepted guidelines. Univariate analyses were performed to identify factors associated with completely adherent or less than completely adherent treatment plans. Results: Standard treatment Non-standard treatment Total N (%) N (%) Stage Stage Stage Stage
0-I, IVECOG active 0-I, IVECOG limited II-IIIECOG active II-IIIECOG limited
9 (90) 15 (93.8) 7 (87.5) 5 (41.7)
1 (10) 1 (6.3) 1 (12.5) 7 (58.3)
10 16 8 12
Of the n = 52 SAO patients analyzed, 77% received standard care, i.e., care completely adherent to guidelines. Stage II and III patients were significantly more likely than stage 0–1 and IV patients to receive non-standard care (RR = 6.3; 95% CI: 1.5 – 26.0). Patients with curable disease tended to receive non-standard care more often than those with non-curable disease (RR = 2.6; 95% CI: 0.7 – 10.8). Among the curable patients, those with functional limitations tended to receive non-standard care more often than the fully active (RR = 6.6; 95% CI: 0.9 – 47.2). Conclusion: These findings may indicate that functional status is more significant than curability in treatment planning for SAO patients. Disclosure of Interest: None declared.
doi:10.1016/j.jgo.2014.09.077 Geriatric Assessment Geriatric Assessment P049 ADHERENCE TO GUIDELINES IN SENIOR ADULT ONCOLOGY PATIENTS: IS STANDARD CARE THE RIGHT CARE? A. Mackenzie1, L.D.O. Koch2, T. Wolf3, J. Cocroft3, S.W. Keith4, J. Schoppe1, A. Barsevick3, R. Myers3, A. Chapman1 1 Oncology, Thomas Jefferson University Hospital, Philadelphia, United States 2 Hospital Israelita Albert Einstein, Sao Paolo, Brazil 3 Population Science, United States 4 Graduate School of Biomedical Sciences, Thomas Jefferson University Hospital, Philadelphia, United States Introduction: Over 50% of new cancer diagnoses occur in senior adult oncology (SAO) patients (≥65 years of age). However, as SAO patients may not be treated with standard care, it is important to assess treatment patterns among SAO patients. Objectives: The objectives of this retrospective review were to: (1) Determine whether senior adult oncology patients seen in a hospitalbased oncology practice received care adherent to or less than adherent to national guidelines, and (2) identify factors that influenced those patterns of care. Methods: The research team performed a retrospective analysis of demographic and clinical predictors of standard versus non-standard care for SAO patients with a potentially curable malignancy. “Patterns of care” was defined by the authors as the treatment plans (including surgery and/or systemic treatment and/or radiation) designed by the treating
P051 A FEASIBILITY TRIAL OF GERIATRIC ASSESSMENT AND MANAGEMENT FOR OLDER CANCER PATIENTS M. Puts1,⁎, M. Krzyzanowska2, E. Amir2, A. Joshua2, J. Monette3, D. Wan-Chow-Wah3, R. Jang2, S. Alibhai4 1 Nursing, University of Toronto, Canada 2 Medical Oncology, Princess Margaret Cancer Centre University Health Network, Toronto, Canada 3 Geriatric Medicine, Jewish General Hospital, Montreal, Canada 4 Medicine, University Health Network, Toronto, Canada
Introduction: The majority of persons diagnosed with cancer are older adults. Treatment decision-making for older adults can be difficult as they often have other diseases and/or functional limitations. The aim of comprehensive geriatric assessment (CGA) in an older population is to identify current health care problems and start interventions to prevent/postpone adverse outcomes and to maintain/improve the functional status and well-being of older adults. A CGA followed by an integrated care plan might help the cancer treatment team better tailor treatment to their older patient and have a positive impact on health and well-being, but there is limited and conflicting evidence to support the effectiveness of CGA in the oncology setting and no randomized controlled trial (RCT) has been completed in this setting. Objectives: What is the efficacy of CGA followed by an integrated care plan in optimizing outcomes in the elderly with advanced breast or gastrointestinal (GI) or genitourinary (GU) cancer?
S48
Abstracts
Methods: We will use a two-group parallel single-blind phase II RCT. The inclusion criteria are: aged 70 years and over, diagnosed with GI, GU or breast cancer, referred for first line chemotherapy or received b2 cycles and b6 weeks after start of chemotherapy at the Princess Margaret Cancer Centre who are able to speak English, have a physician-estimated life expectancy N6 months, ECOG PS 0-2 and able to give informed consent. Randomization to intervention (GA followed by integrated care plan) and control group (usual care by oncologist) will be 1:1 using opaque sealed envelopes and stratified based on treatment intent (adjuvant vs. palliative). Sample size: 60 participants (30 per study arm). The planned intervention includes a full CGA by a multidisciplinary geriatric team followed by an integrated care plan to address the issues identified. The CGA will include the following domains based on guidelines and expert recommendations: 1) Functional status; 2) Medication review; 3) Cognitive assessment; 4) Nutritional status; 5) Comorbidities; 6) Psychological functioning; 7) Social support. Based on this CGA and discussion with the patient, tailored evidence-based interventions will be carried out by the multidisciplinary geriatric team using a standardized intervention protocol. Participants in the intervention group will be seen by the intervention team at baseline for the CGA and development of the integrated care plan; and 2) at 3 months to assess intervention fidelity and measure outcomes. The co-primary outcomes are: 1) Quality of life (EORTC QLQ-C30); 2) Modification of the cancer treatment plan. The secondary outcomes are 1) Functional status (OARS Instrumental Activities of Daily Living); and 2) feasibility of the study by tumour site. Results: preliminary data will be presented at the SIOG meeting. Conclusion: This will be one of the first RCTs of CGA in geriatric oncology to show feasibility and obtain preliminary efficacy estimates to prepare a phase 3 trial. Disclosure of Interest: None declared Keywords: Breast cancer, Clinical trials, Colorectal, Epidemiology doi:10.1016/j.jgo.2014.09.080
Geriatric Assessment P052 ACCURATE CLASSIFICATION OF PERFORMANCE STATUS IN ELDERLY PATIENTS: DESIGN, VALIDATION AND IMPLEMENTATION OF A REMOTE PATIENT ACTIVITY MONITORING DEVICE A. Naeim1,⁎, K.M. Vander Wall1, J. Lucier1, M. Sarrafzadeh2, H.-J.R. Tan3, B. Mortazavi2, E. Nemati2 1 Hematology/Oncology, United States 2 Computer Science, United States 3 Urology, UCLA Medical Center, Los Angeles, United States
Objectives: (1) Evaluate how well pre-operative, pre-transplant and pre-trial cancer patients are able to tolerate and interact with a wireless SmartWatch device (including user-friendliness of the designed software). (2) Determine if activity and quality of life data collected continuously and in real-time by the SmartWatch device demonstrates a different level of pre-operative fitness than a standard onetime clinical assessment. (3) Review the correlation between functional status determined by the SmartWatch device and postoperative complications, length of stay, postoperative re-admissions, and discharge requirements. Methods: This pilot study will recruit 120 cancer patients aged 65 and older prior to planned cancer surgery, stem cell transplant or early-phase clinical trial enrollment. Consent will occur within 4– 6 weeks of planned procedure. At baseline/consent each subject will undergo a comprehensive geriatric assessment, a timed and videotaped “get up and go” test, and multiple validated short form surveys addressing nutritional status, sleep, pain, frailty, cognition, activities of daily living, instrumental activities of daily living, social support, and depression/anxiety. Each subject begins wearing the SmartWatch device at the time of the baseline visit, and it begins to collect data continuously. After completion of the baseline assessment, each subject wears the watch home and then wears the device continuously for a 7-day period. Activity data is collected at a frequency of 10 hz and the same surveys collected at baseline are delivered in a novel dynamic approach electronically to each watch device over the course of the 7-day period. The watch is then returned prior to surgery, clinical trial consent or transplant. Results: This pilot study is currently underway. Interim analysis will be available as late-breaking material prior to the scheduled conference. The analysis will focus on the following: (1) Comparison of one-time geriatric assessment against continuous remote sensing and dynamic questionnaire administration, (2) Usability and Patient Perception and Satisfaction with wearing and interacting with the SmartWatch, (3) Potential cut-off points and ROC curves for performance screening using sensing technology, (4) a summary of methodological issues associated with incorporating novel technology in trials with older cancer patients. Conclusion: We have designed and validated a tool that allows for continuous, passive collection of important performance, functional status, nutritional, cognitive and pain score data. The data generated can provide a meaningful assessment of performance and functional status that is collected in an efficient manner without taking significant time in a busy oncology practice. Disclosure of Interest: None declared. Keywords: Clinical trials, Epidemiology, Translational research doi:10.1016/j.jgo.2014.09.081
Introduction: Recent advances in technology allow for the possibility of more dynamic assessment and monitoring of patients. Within the past 6–12 months, “intelligent” easy to wear electronic devices have been brought to market that are able to collect and transmit various types of biodata—patient position, time in motion, and even responses to questionnaires delivered in a dynamic fashion remotely. These devices may also be able to detect heart rate, blood pressure, temperature and other bio-parameters. These remote sensors will play a critical role in assessing and monitoring vulnerable or frail patient populations at risk of repeated health complications.
Geriatric Assessment P053 DEVELOPMENT AND VALIDATION OF THE DELIRIUM RISK ASSESSMENT SCORE (DRAS) R. Vreeswijk1,⁎, K. Kalisvaart1, I. Kalisvaart2 1 Geriatrics 2 Kennemer Gasthuis, Haarlem, Netherlands