Journal of geriatric oncology最新文献

Introduction: Hospitalized older adults with malignant solid tumor cancer discharged to skilled nursing facilities (SNFs) are at high risk of being "rehabbed to death." These patients have high 6-month mortality, experience burdensome care transitions near the end of life, and have limited access to palliative care. The Assessing and Listening to Individual Goals and Needs (ALIGN) intervention aims to address unmet palliative care needs and leverages the skills of palliative care social workers (PCSWs) to support serious illness communication, decision-making, and caregiver needs. We report the protocol of a pilot randomized controlled trial (RCT) of ALIGN that tests the (a) feasibility of delivering the intervention with fidelity across multiple SNFs, (b) collection of patient-centered outcomes, (c) preliminary efficacy, and (d) risk of contamination.

Materials and methods: This single site, single-blinded, pilot RCT of ALIGN versus enhanced usual care will recruit 60 patients with cancer and up to 60 caregivers from an academic medical center discharged to a SNF. Patients will be randomized 1:1 to ALIGN or enhanced usual care. ALIGN consists of virtual PCSW visits every 1-2 weeks during a SNF stay and for up to 45 days after SNF discharge. ALIGN visits are manualized, theory-driven, and evidence-based, focusing on illness understanding, discussing evolving care preferences, caregiver needs, and care transition needs. The enhanced usual care arm will receive usual care and additional information about advance care planning (ACP). Participants will complete assessments at baseline, 1, 3, and 6-months after enrollment. The primary goal of the pilot RCT is to measure feasibility, defined by enrollment within 20% of the target sample of 60 patients, ≥ 70% intervention completion, <5% missing data for patient-centered outcomes collected in the electronic health record, and < 10% contamination in the control arm based on caregiver report of exposure to ALIGN content from SNF staff. Fidelity will be assessed through checklists, review of visit notes, and auditing of audio-recorded visits.

Discussion: This trial will test whether ALIGN can be delivered feasibly and with high fidelity across multiple SNFs, a high-risk transition point for older adults with cancer. Findings will inform a fully powered efficacy trial of ALIGN.

Introduction: Older adults with early-stage non-small cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT) have a high competing risk of adverse cardiac events, but adherence to guideline-directed cardiovascular care remains unclear. This study examined cardiovascular risk, management, and outcomes among older adults with early-stage NSCLC receiving SBRT.

Materials and methods: This retrospective cohort study included patients aged ≥65 with early-stage NSCLC who completed SBRT between 2019 and 2023 at our institution. The following were assessed: (1) 10-year atherosclerotic cardiovascular disease (ASCVD) Framingham risk score, (2) baseline rates of guideline-directed management for hypertension, hyperlipidemia, and diabetes, (3) primary care and cardiology visits in the year before and after SBRT, and (4) competing risk-adjusted cumulative incidence of major adverse cardiac events (MACE).

Results: Among 330 patients (median age 77.1 years, 61.8% female), 98.5% (n = 325) had cardiovascular comorbidities, including hypertension (88.2%, n = 291) and hyperlipidemia (86.4%, n = 285). At SBRT initiation, 30.6% (n = 101) had prior ASCVD, and 91.8% (n = 303) were at high, or very high risk for future events based on their history or calculated risk score. Following SBRT, at a median follow-up of 21.3 months (IQR 12.8-33.6 months), 17.6% (n = 58) experienced MACE, with a risk-adjusted cumulative incidence at 2 years of 13.0%. Guideline-directed management was infrequent: 45.7% (n = 133) for hypertension, 28.7% (n = 82) for hyperlipidemia, and 30.3% (n = 20) for diabetes. Before and after SBRT, more than half of patients had no primary care or cardiology visits (pre: 54.5%; post: 55.8%).

Discussion: Older adults undergoing SBRT face substantial cardiovascular risk, but many do not receive appropriate preventive care. These findings highlight opportunities for multidisciplinary collaboration to support age-appropriate cardiovascular assessment and care delivery.

Introduction: Healthcare is increasingly shifting from a paternalistic model to one that prioritises person-centred care (PCC). Despite this trend, implementing PCC in the care of older adults diagnosed with cancer remains challenging. The Age-Friendly Health Systems (AFHS) initiative provides a structured framework - the 4Ms (What Matters, Medication, Mentation, and Mobility) - to promote consistent, evidence-based care for older adults. It has demonstrated benefits in general geriatric care; however, applying the 4Ms principles in oncology is underexplored. This study aimed to assess the feasibility of enhancing geriatric assessment (GA) by integrating two novel person-centred elements: Photovoice (two patient-supplied photographs inspired by "Photovoice" principles but not constituting a full Photovoice methodology) and the "This is Me" (TiM) tool.

Materials and methods: A cross-sectional mixed-methods study evaluated the feasibility of integrating two novel elements (two patient-supplied photographs and the TiM tool) into GA, with the aim of promoting practice based on the AFHS 4Ms framework principles. Twenty consecutive patients (≥70 years, G8 score ≤ 14) from a regional cancer centre completed the assessment (electronic Rapid Fitness Assessment [eRFA]-Photo-TiM, as well as the Mini-Cog and Timed-Up-and-Go). Results were presented at a weekly "enhanced supportive care" (ESC) multidisciplinary team (MDT) meeting. Participants completed post-assessment surveys and interviews.

Results: All patients (n = 20), aged 79 years, 45% female, completed the eRFA, 19 completed the TiM, and 18 provided photographs. The combined assessment was overall acceptable and feasible, user-friendly, captured patients' values and contexts, and facilitated supportive care referrals and advance care planning discussions. ESC-MDT members valued the holistic view for informing supportive care decisions. However, photo submission required substantial assistance for most participants, hence a significant barrier to overcome for implementation. Other barriers included digital literacy and delays in completion, which averaged 2.5 weeks.

Discussion: The eRFA-Photo-TiM approach was feasible and acceptable in a real-world cancer care in a regional cancer centre and may support more person-centred care decision making. Further research should evaluate effect on cancer care outcomes and sustainable implementation.

Introduction: We aimed to evaluate population-based outcomes of chemoradiation therapy (CRT) for muscle-invasive bladder cancer given a lack of population-based data, particularly in older adults.

Materials and methods: We conducted observational analyses using SEER-Medicare based on the CRT protocol in the control arm of SWOG/NRG 1806. We included adults aged 66-89 years with T2-T4a N0 M0 urothelial bladder cancer treated with radiation and concurrent chemotherapy (cisplatin, gemcitabine, or 5-FU + mitomycin C) within 90 days of transurethral resection of bladder tumor (TURBT) from 2000 to 2017. We examined progression-free (PFS), cancer-specific (CSS), and overall survival (OS) using claims-based proxies and the Kaplan-Meier method. Associations of baseline characteristics with outcomes were evaluated using Cox regression.

Results: A total of 283 patients were included. Median age was 78 years (IQR 73-82), and tumor stage was T2 in 247 (87%) patients. Median follow-up was 26.0 months. At five years, PFS was 47%, CSS was 53%, and OS was 35%. On multivariable analysis, female sex (HR 1.74) was associated with increased risk of cancer-specific mortality (CSM), while higher education level (HR 0.37 for <14% without high school education versus >29%) was associated with reduced CSM.

Discussion: Notwithstanding the limitations of SEER-Medicare, in observational analyses designed to evaluate outcomes of a hypothetical single-arm trial, CRT was associated with lower CSS and OS than reported in prior clinical trials. Additional studies are required to determine if this is related to the efficacy or completeness of CRT in population-based practices or differences between trial and non-trial populations.