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Expert Point of View: William Dale, MD, PhD


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"We have known for a long time, based on good evidence, that geriatric assessment is good at accurately identifying patients at high risk for chemotherapy-induced toxicity, surgical complications, and increased hospitalizations. This study adds an intervention component based on the geriatric assessment; that is, a multidisciplinary team took action to mitigate concerns identified in the assessment to improve outcomes in these older patients undergoing chemotherapy,” said William Dale, MD, PhD, Department Chair of Supportive Care Medicine and Director of the Center for Cancer and Aging at City of Hope, Duarte, California, and a member of ASCO’s Communications Committee.

William Dale, MD, PhD

William Dale, MD, PhD

“This study is one of the first demonstrations in a randomized trial that taking action on the geriatric assessment with a multidisciplinary team can change outcomes such as quality of life, risk of hospitalization, and risk of not completing cancer treatments,” Dr. Dale explained.

“This study focused on a multidisciplinary team led by a geriatrician,” Dr. Dale reviewed. “The team reviewed the issues raised by the geriatric assessment and, based on their clinical judgment, took targeted actions. An example might be they noticed a patient who had a fall within the past 6 months, so they would implement physical therapy to work on balance and strength. Or a patient may be on too many medicines, so they would review the medications to minimize the level of polypharmacy and reduce the risk of drug-related problems.”

“Geriatric assessment is the ‘secret sauce’ to help older adults with cancer over the long term and combine these multidisciplinary team interventions with cancer treatments,” Dr. Dale continued. “This type of integrated care does exist at certain institutions where research is being conducted in this field, such as City of Hope, University of Rochester, Dana-Farber Cancer Institute, University of Chicago, and Moffitt Cancer Center. These organizations have been studying it and integrating it into their oncology practices. However, right now, it is still relatively rare, especially in community settings,” he commented.

Future Implications

“The hope is level 1 evidence like this with this type of guided care showing decreased hospitalizations and health-care system savings will lead to more widespread adoption of geriatric assessment and associated interventions as we focus on value-based care,” Dr. Dale proposed. “If a geriatric assessment costs less than a day in the hospital for a patient, which is clearly true, that would be a good investment for a system. My sense is that in the not-too-distant future, we will see more of this.”

Dr. Dale mentioned future research possibilities. “One avenue of research this opens up will be ways to reduce the burden of geriatric assessment, in terms of time for patients and resources for practices, and still obtain the outcome benefits we seek,” he said.

“The assessment in this study was a full-assessment geriatric assessment across multiple domains with a complete team intervention, which may not be practical in many settings. Other studies have shown benefits with less intensive interventions. We will learn which tools give you the most success in identifying problems, reducing unnecessary hospitalizations, and improving outcomes, such as functional and cognitive status,” Dr. Dale said. 

DISCLOSURE: Dr. Dale reported no conflicts of interest.

 


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