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NCT02054741

Geriatric Assessment Intervention for Reducing Toxicity in Older Patients With Advanced Cancer

Completed NA Results posted Last updated 12 April 2024
What this trial tests

NA trial testing Comprehensive Geriatric Assessment in Adult Solid Neoplasm in 733 participants. Completed in 31 October 2021.

Timeline
29 July 2014
Primary endpoint
31 October 2021
31 October 2021

Quick facts

Lead sponsorSupriya Mohile
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposesupportive care
Enrollment733
Start date29 July 2014
Primary completion31 October 2021
Estimated completion31 October 2021
Sites23 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Supriya Mohile

Who can join

70 and older, any sex, with Adult Solid Neoplasm or Toxicity. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Patient Experienced Any Grade 3-5 Toxicity Primary · 3 months

Proportion of patients who experienced grade 3-5 toxicity within 3 months of initiation of new treatment regimen. Toxicity was graded according to the National Cancer Institute (NCI) CTCAE version (v)4.0.

GroupValue95% CI
Arm I (GA Intervention)0.51
Arm II (Usual Care)0.71
Patient Survival at 6 Months Secondary · 6 months

Proportion of patients who were alive at 6 months (183 days) after enrollment estimated by Kaplan-Meier method.

GroupValue95% CI
Arm I (GA Intervention)0.71
Arm II (Usual Care)0.74
Reduced Dose Intensity Secondary · 4-6 weeks

Proportion of patients with reduced dose intensity in cycle 1.

GroupValue95% CI
Arm I (GA Intervention)0.49
Arm II (Usual Care)0.35
GA-driven Recommendations Made Among Patients With Impaired Physical Performance. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired physical performance and starting a new treatment regimen for advanced cancer. Physical Performance measures included: Timed Up and Go, Short Physical Performance Battery, Falls History, and OARS Physical Health.

Refer to: physical therapist (outpatient or home-based depending on eligibility for home care)
GroupValue95% CI
Arm I (GA Intervention)74
Refer to: occupational therapist
GroupValue95% CI
Arm I (GA Intervention)35
Refer to: aide services
GroupValue95% CI
Arm I (GA Intervention)45
Refer to: personal emergency response information
GroupValue95% CI
Arm I (GA Intervention)62
Refer to: vision specialist if difficulties
GroupValue95% CI
Arm I (GA Intervention)38
Physical Examination: check orthostatic blood pressure
GroupValue95% CI
Arm I (GA Intervention)92
Physical Examination: decrease/eliminate blood pressure meds if blood pressure is low or low normal
GroupValue95% CI
Arm I (GA Intervention)67
Medication Review: minimize psychoactive meds including those used for supportive care
GroupValue95% CI
Arm I (GA Intervention)115
GA-driven Recommendations Made Among Patients With Impaired Functional Status. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired functional status and starting a new treatment regimen for advanced cancer. Functional Status measures included: Activities of Daily Living and Instrumental Activities of Daily Living.

Refer to: occupational therapist
GroupValue95% CI
Arm I (GA Intervention)26
Refer to: aide services
GroupValue95% CI
Arm I (GA Intervention)32
Refer to: personal emergency response information
GroupValue95% CI
Arm I (GA Intervention)45
Refer to: home nursing services
GroupValue95% CI
Arm I (GA Intervention)25
Physical Examination: check orthostatic blood pressure
GroupValue95% CI
Arm I (GA Intervention)56
Physical Examination: decrease/eliminate blood pressure meds if blood pressure is low or low normal
GroupValue95% CI
Arm I (GA Intervention)40
Medication Review: minimize psychoactive meds including those used for supportive care
GroupValue95% CI
Arm I (GA Intervention)74
Medication Review: minimize duplicative medications
GroupValue95% CI
Arm I (GA Intervention)103
GA-driven Recommendations Made Among Patients With Impaired Comorbidities. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired comorbidities and starting a new treatment regimen for advanced cancer. Comorbidity measure included: OARS Comorbidity.

Initiate direct communication with patient's primary care physician about the cancer treatment plan
GroupValue95% CI
Arm I (GA Intervention)201
Modify treatment choices: diabetes history- avoid neurotoxic agents if another option is equivalent
GroupValue95% CI
Arm I (GA Intervention)45
Modify treatment choices: heart failure history - minimize volume/infusion rate of agents
GroupValue95% CI
Arm I (GA Intervention)28
Modify treatment choices: renal impairment history - adjust as appropriate
GroupValue95% CI
Arm I (GA Intervention)45
Modify treatment choices: Modify dosage/schedule if concern about tolerance/worsening comorbidities
GroupValue95% CI
Arm I (GA Intervention)113
Provide smoking cessation counseling if the patient currently smokes
GroupValue95% CI
Arm I (GA Intervention)10
GA-driven Recommendations Made Among Patients With Impaired Cognition. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired cognition and starting a new treatment regimen for advanced cancer. Cognition measures included: Blessed Orientation Memory Concentration and Mini Cog assessments.

Assess decision-making capacity and if lacking elicit health care proxy information and input
GroupValue95% CI
Arm I (GA Intervention)88
Refer to: clinician experienced in memory care
GroupValue95% CI
Arm I (GA Intervention)10
Refer to: social work
GroupValue95% CI
Arm I (GA Intervention)43
Refer to: palliative care
GroupValue95% CI
Arm I (GA Intervention)22
Nueropsychological testing if dementia is suspected
GroupValue95% CI
Arm I (GA Intervention)6
TSH if dementia is suspected
GroupValue95% CI
Arm I (GA Intervention)12
B12 if dementia is suspected
GroupValue95% CI
Arm I (GA Intervention)12
Brain imaging
GroupValue95% CI
Arm I (GA Intervention)16
GA-driven Recommendations Made Among Patients With Impaired Nutrition. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired nutrition and starting a new treatment regimen for advanced cancer. Nutrition measures included: Body Mass Index, Weight Loss, and Mini Nutrition Assessment.

Refer to: nutritionist/clinical dietician
GroupValue95% CI
Arm I (GA Intervention)93
Refer to: meals-on-wheels
GroupValue95% CI
Arm I (GA Intervention)13
Refer to: dentist if poor dentition or denture issues
GroupValue95% CI
Arm I (GA Intervention)20
Refer to: speech and swallow if difficulty with swallowing
GroupValue95% CI
Arm I (GA Intervention)10
Inform: nutrition handout
GroupValue95% CI
Arm I (GA Intervention)169
Treatment modification: use caution with highly emetogenic regimens and use another if appropriate
GroupValue95% CI
Arm I (GA Intervention)135
Treatment modification: utilize aggressive anti-emetic therapy
GroupValue95% CI
Arm I (GA Intervention)153
Treatment modification: conduct frequent toxicity check
GroupValue95% CI
Arm I (GA Intervention)192
GA-driven Recommendations Made Among Patients With Impaired Social Support. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired social support and starting a new treatment regimen for advanced cancer. Social Support measure included: OARS Medical Social Support.

Confirm documented health care proxy is in medical record
GroupValue95% CI
Arm I (GA Intervention)78
Modify treatment choice and/or dosage
GroupValue95% CI
Arm I (GA Intervention)67
Refer or inform: ride assistance program
GroupValue95% CI
Arm I (GA Intervention)22
Refer or inform: social worker via on-site or visiting nurse services
GroupValue95% CI
Arm I (GA Intervention)51
Refer of inform: social worker via online services
GroupValue95% CI
Arm I (GA Intervention)0
Refer or inform: visiting nurse service or home health aide (if meets criteria)
GroupValue95% CI
Arm I (GA Intervention)17
Refer or inform: alternative living environments
GroupValue95% CI
Arm I (GA Intervention)0
Refer or inform: assistance programs
GroupValue95% CI
Arm I (GA Intervention)0
GA-driven Recommendations Made Among Patients With Impaired Polypharmacy. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired polypharmacy and starting a new treatment regimen for advanced cancer. Polypharmacy measure included: medication review.

Ask patient to bring in prescribed, OTC medications, and supplements to review at the next visit
GroupValue95% CI
Arm I (GA Intervention)158
Contact primary care provider to help reduce regimen complexity
GroupValue95% CI
Arm I (GA Intervention)82
Reduce medicines solely used for hypertension or diabetes if appropriate
GroupValue95% CI
Arm I (GA Intervention)59
Consult the pharmacist to synchronize medication refills
GroupValue95% CI
Arm I (GA Intervention)52
Have pharmacist meet with the patient to evaluate drug interactions and medication counseling
GroupValue95% CI
Arm I (GA Intervention)59
Provide written instructions for taking new medications
GroupValue95% CI
Arm I (GA Intervention)184
Recommend pillbox and/or medication calendar
GroupValue95% CI
Arm I (GA Intervention)123
Provide handout on polypharmacy
GroupValue95% CI
Arm I (GA Intervention)223
GA-driven Recommendations Made Among Patients With Impaired Psychological Status. Secondary · Baseline

The type and frequency of GA-driven recommendations implemented for older patients with impaired psychological status and starting a new treatment regimen for advanced cancer. Psychological measures included: Geriatric Depression Scale and Generalized Anxiety Disorder - 7 item scale.

Provide written or verbal communication with primary care physician
GroupValue95% CI
Arm I (GA Intervention)44
Refer to: counseling or psychotherapy
GroupValue95% CI
Arm I (GA Intervention)20
Refer to: social work
GroupValue95% CI
Arm I (GA Intervention)42
Refer to: spiritual counseling or Chaplaincy services
GroupValue95% CI
Arm I (GA Intervention)18
Refer to: psychiatry if severe symptoms or if already on medications which are not adequate
GroupValue95% CI
Arm I (GA Intervention)11
Refer to: palliative care if other physical and/or cancer symptoms are present
GroupValue95% CI
Arm I (GA Intervention)24
Initiate pharmacologic therapy if appropriate in conjunction with primary care provider
GroupValue95% CI
Arm I (GA Intervention)18
Provide linkage to community resources
GroupValue95% CI
Arm I (GA Intervention)30

Sponsor's own description

This cluster randomized clinical trial compares a geriatric assessment intervention with usual care for reducing cancer treatment toxicity in older patients with cancer that has spread to other places in the body. A geriatric assessment may identify risk factors for cancer treatment toxicity and may improve outcomes for older patients with advanced cancer.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer.
    Hurria A, Mohile S, Gajra A, Klepin H, et al · · 2016 · cited 426× · PMID 27185838 · DOI 10.1200/jco.2015.65.4327
  2. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
    Mohile SG, Mohamed MR, Xu H, Culakova E, et al · · 2021 · cited 397× · PMID 34741815 · DOI 10.1016/s0140-6736(21)01789-x
  3. Older adult participation in cancer clinical trials: A systematic review of barriers and interventions.
    Sedrak MS, Freedman RA, Cohen HJ, Muss HB, et al · · 2021 · cited 367× · PMID 33002206 · DOI 10.3322/caac.21638
  4. Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment.
    Caillet P, Laurent M, Bastuji-Garin S, Liuu E, et al · · 2014 · cited 113× · PMID 25302022 · DOI 10.2147/cia.s57849
  5. Older adults with cancer and their caregivers - current landscape and future directions for clinical care.
    Kadambi S, Loh KP, Dunne R, Magnuson A, et al · · 2020 · cited 107× · PMID 32879429 · DOI 10.1038/s41571-020-0421-z
  6. Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment.
    Ramsdale E, Mohamed M, Yu V, Otto E, et al · · 2022 · cited 63× · PMID 35348764 · DOI 10.1093/oncolo/oyac053
  7. Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer.
    Mohile SG, Magnuson A, Pandya C, Velarde C, et al · · 2018 · cited 63× · PMID 29523669 · DOI 10.6004/jnccn.2017.7047
  8. Association of polypharmacy and potential drug-drug interactions with adverse treatment outcomes in older adults with advanced cancer.
    Mohamed MR, Mohile SG, Juba KM, Awad H, et al · · 2023 · cited 53× · PMID 36692475 · DOI 10.1002/cncr.34642

Verify or expand the search:

Other trials of Comprehensive Geriatric Assessment

Trials testing the same drug.

Other recruiting trials for Adult Solid Neoplasm

Currently open trials in the same condition.

Other Supriya Mohile trials

Trials by the same sponsor.

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Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing