In the COACH study, reported in JAMA Oncology, Supriya G. Mohile, MD, MS, and colleagues found that including geriatric assessment in oncology visits for older adults with advanced cancer improved patient and caregiver satisfaction with communication regarding aging-related concerns.
Study Details
In the cluster-randomized trial, 541 patients from 31 community oncology practices within the University of Rochester National Cancer Institute Community Oncology Research Program were randomly assigned by practice between October 2014 and April 2017 to receive a geriatric assessment intervention (n = 293; 231 caregivers) or usual care (n = 248; 183 caregivers). Patients had to be aged ≥ 70 years with an advanced solid tumor or lymphoma, and also have impairment in ≥ 1 geriatric assessment domain on baseline assessment.
“Including [geriatric assessment] in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns.”— Supriya G. Mohile, MD, MS, and colleagues
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All patients underwent a geriatric assessment evaluating the domains of functional status, physical performance, comorbidity, polypharmacy, cognition, nutrition, psychological health, and social support. The intervention group received a tailored geriatric assessment summary with recommendations for each patient; usual care consisted of alerts for only those patients meeting criteria for depression or cognitive impairment.
The primary outcome measure was patient satisfaction with communication about aging-related concerns on the modified Health Care Climate Questionnaire (HCCQ; 0–28 scale, with higher score indicating greater satisfaction) measured after the first oncology visit after baseline geriatric assessment.
Key Findings
After the first oncology visit, patients in the intervention group indicated greater satisfaction vs the usual-care group with communication about aging-related concerns (HCCQ mean score among all patients = 22.8 points; difference favoring intervention group = 1.09 points, P = .04). Increased satisfaction in the intervention group persisted over 6 months (difference in mean score = 1.10, P = .04).
The intervention group reported greater satisfaction with overall care at 6 months (difference in mean HCCQ score = 0.70, P = .03).
The adjusted mean number of conversations regarding aging-related concerns during the initial oncology visit was 8.02 per patient in the intervention group vs 4.43 in the usual-care group (P < .001), including 4.60 vs 2.59 high-quality conversations (P < .001), and 3.20 vs 1.14 conversations about geriatric assessment-driven recommendations (P < .001).
Caregivers in the intervention group expressed greater satisfaction with communication regarding aging-related concerns vs usual-care group caregivers after the first visit (difference in mean HCCQ score = 1.05, P = .03).
No difference in quality-of-life outcomes was observed between groups.
The investigators concluded: “Including [geriatric assessment] in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns.”
Dr. Mohile, of the Department of Medicine, University of Rochester, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Patient-Centered Outcomes Research Institute, National Institute of Aging, and National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
