{"doi":"10.3389/fonc.2022.835582","title":"A Geriatric Assessment Intervention to Reduce Treatment Toxicity Among Older Adults With Advanced Lung Cancer: A Subgroup Analysis From a Cluster Randomized Controlled Trial","abstract":"Introduction More older adults die from lung cancer worldwide than breast, prostate, and colorectal cancers combined. Current lung cancer treatments may prolong life, but can also cause considerable treatment-related toxicity. Objective This study is a secondary analysis of a cluster-randomized clinical trial which evaluated whether providing a geriatric assessment (GA) summary and GA-guided management recommendations can improve grade 3-5 toxicity among older adults with advanced lung cancer. Methods We analyzed participants aged ≥70 years(y) with stage III & IV (advanced) lung cancer and ≥1 GA domain impairment starting a new cancer treatment with high-risk of toxicity within the National Cancer Institute’s Community Oncology Research Program. Community practices were randomized to the intervention arm (oncologists received GA summary & recommendations) versus usual care (UC: no summary or recommendations given). The primary outcome was grade 3-5 toxicity through 3 months post-treatment initiation. Secondary outcomes included 6-month (mo) and 1-year overall survival (OS), treatment modifications, and unplanned hospitalizations. Outcomes were analyzed using generalized linear mixed and Cox proportional hazards models with practice site as a random effect. Trial Registration: NCT02054741. Results & Conclusion Among 180 participants with advanced lung cancer, the mean age was 76.3y (SD 5.1), 39.4% were female and 82.2% had stage IV disease. The proportion of patients who experienced grade 3-5 toxicity was significantly lower in the intervention arm vs UC (53.1% vs 71.6%, P=0.01). More participants in the intervention arm received lower intensity treatment at cycle 1 (56.3% vs 35.3%; P<0.01). Even with a cycle 1 dose reduction, OS at 6mo and 1 year was not significantly different (adjusted hazard ratio [HR] intervention vs. UC: 6mo HR=0.90, 95% CI: 0.52-1.57, P=0.72; 1 year HR=0.89, 95% CI: 0.58-1.36, P=0.57). Frequent toxicity checks, providing education and counseling materials, and initiating direct communication with the patient’s primary care physician were among the most common GA-guided management recommendations. Providing a GA summary and management recommendations can significantly improve tolerability of cancer treatment among older adults with advanced lung cancer.","journal":"Frontiers in Oncology","year":2022,"id":268763,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9477,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":266571,"name":"Mostafa Mohamed","orcid":"0000-0003-2936-5794","position":1,"is_corresponding":false},{"id":266567,"name":"Eva Culakova","orcid":"0000-0002-9852-6515","position":2,"is_corresponding":false},{"id":266574,"name":"Marie Flannery","orcid":"0000-0003-2957-8482","position":3,"is_corresponding":false},{"id":931510,"name":"Pooja Vibhakar","orcid":null,"position":4,"is_corresponding":false},{"id":682186,"name":"Rebecca Hoyd","orcid":"0000-0003-1210-4491","position":5,"is_corresponding":false},{"id":355343,"name":"Arya Amini","orcid":"0000-0002-8311-9159","position":6,"is_corresponding":false},{"id":729831,"name":"Noam A. VanderWalde","orcid":"0000-0001-7483-0582","position":7,"is_corresponding":false},{"id":411529,"name":"Melisa L. Wong","orcid":"0000-0001-6390-6959","position":8,"is_corresponding":false},{"id":930951,"name":"Yukari Tsubata","orcid":"0000-0002-4260-2849","position":9,"is_corresponding":false},{"id":336029,"name":"Daniel Spakowicz","orcid":"0000-0003-2314-6435","position":10,"is_corresponding":false},{"id":266566,"name":"Supriya G. Mohile","orcid":"0000-0003-0867-327X","position":11,"is_corresponding":false},{"id":336037,"name":"Carolyn J. Presley","orcid":"0000-0002-2607-5639","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T00:27:14.088663Z","pmid":"35433441","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}