Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study

RCT (n=718, mean age 77.2 years) found a geriatric assessment intervention for older patients with advanced cancer reduced serious toxic effects from cancer treatment (grade 3–5 effects in 177 of 349 [51%] vs. 263 of 360 [71%] usual care group;RR 0.74; 95% CI 0.64–0.86; p=0.0001)

SPS commentary:

According to a commentary, although some previous evidence has suggested that a geriatric assessment-based approach to cancer treatment selection might benefit patients, this trial is the first to describe such benefit in a RCT reflecting daily practice. It notes that the study intervention was widely applicable and requires little time investment from health-care providers, allowing the oncologist to retain their decision-making autonomy. It adds that differences in health-care systems and culture might affect the availability and likelihood of chemotherapy use as well as patient willingness to accept such treatment. The current study focused on the palliative setting, and it questions whether the geriatric assessment-based intervention would have a similar impact on older patients receiving chemotherapy in a curative setting, where considerations regarding benefit and willingness to accept toxic effects might differ. Similarly, fit older patients for whom high age is the primary factor limiting their physiological reserves might also benefit from recommendations regarding primary dose reduction or additional toxicity checks. It suggests that it would be worthwhile to repeat this trial in a range of settings and patient populations but concludes that this research represents a leap forward in geriatric oncology and provides strong support that integration of geriatric assessment-based management into daily clinical practice should become the standard of care for older patients with cancer.

 

Source:

The Lancet

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