{"doi":"10.1200/jco.22.00738","title":"Effects of a Geriatric Assessment Intervention on Patient-Reported Symptomatic Toxicity in Older Adults With Advanced Cancer","abstract":"<jats:sec><jats:title>PURPOSE</jats:title><jats:p> Providing a geriatric assessment (GA) summary with management recommendations to oncologists reduces clinician-rated toxicity in older patients with advanced cancer receiving treatment. This secondary analysis of a national cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02054741 ) aims to assess the effects of a GA intervention on symptomatic toxicity measured by Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE). </jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p> From 2014 to 2019, the study enrolled patients age ≥ 70 years, with advanced solid tumors or lymphoma and ≥ 1 GA domain impairment, who were initiating a regimen with high prevalence of toxicity. Patients completed PRO-CTCAEs, including the severity of 24 symptoms (11 classified as core symptoms) at enrollment, 4-6 weeks, 3 months, and 6 months. Symptoms were scored as grade ≥ 2 (at least moderate) and grade ≥ 3 (severe/very severe). Symptomatic toxicity was determined by an increase in severity during treatment. A generalized estimating equation model was used to assess the effects of the GA intervention on symptomatic toxicity. </jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p> Mean age was 77 years (range, 70-96 years), 43% were female, and 88% were White, 59% had GI or lung cancers, and 27% received prior chemotherapy. In 706 patients who provided PRO-CTCAEs at baseline, 86.1% reported at least one moderate symptom and 49.7% reported severe/very severe symptoms at regimen initiation. In 623 patients with follow-up PRO-CTCAE data, compared with usual care, fewer patients in the GA intervention arm reported grade ≥ 2 symptomatic toxicity (overall: 88.9% v 94.8%, P = .035; core symptoms: 83.4% v 91.7%, P = .001). The results for grade ≥ 3 toxicity were comparable but not significant ( P &gt; .05). </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p> In the presence of a high baseline symptom burden, a GA intervention for older patients with advanced cancer reduces patient-reported symptomatic toxicity. </jats:p></jats:sec>","journal":"Journal of Clinical Oncology","year":2023,"id":618577,"datarank":0.5333022092234121,"base_score":3.5553480614894135,"endowment":3.5553480614894135,"self_citation_contribution":0.5333022092234121,"citation_network_contribution":0.0,"self_endowment_contribution":0.5333022092234121,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":34,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":266566,"name":"Supriya G. Mohile","orcid":"0000-0003-0867-327X","position":1,"is_corresponding":false},{"id":420855,"name":"Luke J. Peppone","orcid":"0000-0002-0346-5191","position":2,"is_corresponding":false},{"id":336515,"name":"Erika Ramsdale","orcid":"0000-0002-2246-168X","position":3,"is_corresponding":false},{"id":266571,"name":"Mostafa Mohamed","orcid":"0000-0003-2936-5794","position":4,"is_corresponding":false},{"id":266569,"name":"Huiwen Xu","orcid":"0000-0002-4033-0659","position":5,"is_corresponding":false},{"id":269135,"name":"Megan Wells","orcid":null,"position":6,"is_corresponding":false},{"id":996260,"name":"Rachael Tylock","orcid":"0000-0002-5348-4470","position":7,"is_corresponding":false},{"id":1595888,"name":"Jim Java","orcid":"0000-0002-8254-3177","position":8,"is_corresponding":false},{"id":266580,"name":"Kah Poh Loh","orcid":"0000-0002-6978-0418","position":9,"is_corresponding":false},{"id":336516,"name":"Allison Magnuson","orcid":"0000-0002-0968-8265","position":10,"is_corresponding":false},{"id":1595890,"name":"Leah Jamieson","orcid":"0000-0003-1766-1641","position":11,"is_corresponding":false},{"id":1595892,"name":"Victor Vogel","orcid":null,"position":12,"is_corresponding":false},{"id":266573,"name":"Paul R. Duberstein","orcid":"0000-0001-6882-0898","position":13,"is_corresponding":false},{"id":953291,"name":"Benjamin P. Chapman","orcid":"0000-0002-5170-3131","position":14,"is_corresponding":false},{"id":278736,"name":"William Dale","orcid":"0000-0001-8674-9394","position":15,"is_corresponding":false},{"id":266574,"name":"Marie Flannery","orcid":"0000-0003-2957-8482","position":16,"is_corresponding":false},{"id":266567,"name":"Eva Culakova","orcid":"0000-0002-9852-6515","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Effects of a Geriatric Assessment Intervention on Patient-Reported Symptomatic Toxicity in Older Adults With Advanced Cancer","abstract":"<jats:sec><jats:title>PURPOSE</jats:title><jats:p> Providing a geriatric assessment (GA) summary with management recommendations to oncologists reduces clinician-rated toxicity in older patients with advanced cancer receiving treatment. This secondary analysis of a national cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02054741 ) aims to assess the effects of a GA intervention on symptomatic toxicity measured by Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE). </jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p> From 2014 to 2019, the study enrolled patients age ≥ 70 years, with advanced solid tumors or lymphoma and ≥ 1 GA domain impairment, who were initiating a regimen with high prevalence of toxicity. Patients completed PRO-CTCAEs, including the severity of 24 symptoms (11 classified as core symptoms) at enrollment, 4-6 weeks, 3 months, and 6 months. Symptoms were scored as grade ≥ 2 (at least moderate) and grade ≥ 3 (severe/very severe). Symptomatic toxicity was determined by an increase in severity during treatment. A generalized estimating equation model was used to assess the effects of the GA intervention on symptomatic toxicity. </jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p> Mean age was 77 years (range, 70-96 years), 43% were female, and 88% were White, 59% had GI or lung cancers, and 27% received prior chemotherapy. In 706 patients who provided PRO-CTCAEs at baseline, 86.1% reported at least one moderate symptom and 49.7% reported severe/very severe symptoms at regimen initiation. In 623 patients with follow-up PRO-CTCAE data, compared with usual care, fewer patients in the GA intervention arm reported grade ≥ 2 symptomatic toxicity (overall: 88.9% v 94.8%, P = .035; core symptoms: 83.4% v 91.7%, P = .001). The results for grade ≥ 3 toxicity were comparable but not significant ( P &gt; .05). </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p> In the presence of a high baseline symptom burden, a GA intervention for older patients with advanced cancer reduces patient-reported symptomatic toxicity. </jats:p></jats:sec>","is_dataset_classified":null,"base_score":3.5553480614894135,"endowment":3.5553480614894135,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36356279","pmcid":"PMC9901996","openalex_id":"https://openalex.org/W4308773140","authors":[],"funders":[{"funder_name":"NCI NIH HHS","grant_id":"R01 CA177592","title":null},{"funder_name":"NIA NIH HHS","grant_id":"K24 AG055693","title":null},{"funder_name":"NIA NIH HHS","grant_id":"R03 AG073985","title":null},{"funder_name":"NIA NIH HHS","grant_id":"R33 AG059206","title":null},{"funder_name":"NCI NIH HHS","grant_id":"U01 CA233167","title":null},{"funder_name":"NCI NIH HHS","grant_id":"UG1 CA189961","title":null},{"funder_name":"NIA NIH HHS","grant_id":"K24 AG056589","title":null},{"funder_name":"NCI NIH HHS","grant_id":"R00 CA237744","title":null},{"funder_name":"NIA NIH HHS","grant_id":"P30 AG024832","title":null},{"funder_name":"National Institutes of Health","grant_id":"5UG1CA189961-03","title":"University of Rochester-NCORP Research Base"},{"funder_name":"National Institutes of Health","grant_id":"1K24AG056589-01A1","title":"A Patient-Oriented Research Program in Geriatric Oncology"},{"funder_name":"National Institutes of Health","grant_id":"5U01CA233167-02","title":"Understanding Treatment Tolerability in Older Patients with Cancer"},{"funder_name":"National Institutes of Health","grant_id":"5P30AG024832-04","title":"CORE--METABOLISM RESEARCH"},{"funder_name":"National Institutes of Health","grant_id":"5R00CA237744-04","title":"A novel mobile health exercise intervention for older patients with myeloid neoplasms"},{"funder_name":"National Institutes of Health","grant_id":"5R01CA177592-02","title":"Reducing Chemotherapy Toxicity in Older Adults"}],"total_grants":15,"fwci":3.8671,"citation_percentile":0.94900561,"influential_citations":0,"citation_trend":[{"year":2023,"count":14},{"year":2024,"count":5},{"year":2025,"count":12},{"year":2026,"count":3}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://ascopubs.org/doi/pdfdirect/10.1200/JCO.22.00738?role=tab","host_type":"journal"},{"url":"https://ascopubs.org/doi/pdfdirect/10.1200/JCO.22.00738?role=tab","host_type":"HYBRID"},{"url":"https://ascopubs.org/doi/pdfdirect/10.1200/JCO.22.00738?role=tab","host_type":"publisher"},{"url":"https://ascopubs.org/doi/pdfdirect/10.1200/JCO.22.00738","host_type":"publisher"},{"url":"https://doi.org/10.1200/jco.22.00738","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36356279","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9901996","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC9901996","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC9901996?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1200/JCO.22.00738","host_type":""}],"fields_of_study":["Frailty in Older Adults","Nutrition and Health in Aging","Cancer survivorship and care","Medicine","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":["Patient Reported Outcome Measures","Aged","Female","Humans","Lung Neoplasms","Male","Neoplasms","Geriatric Assessment"],"keywords":["Medicine","Common Terminology Criteria for Adverse Events","Toxicity","Internal medicine","Adverse effect","Regimen","Cancer","Geriatric oncology","Pediatrics","Male","Lung Neoplasms","Neoplasms","Humans","Female","ORIGINAL REPORTS","Patient Reported Outcome Measures","Geriatric Assessment","Aged"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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