Clinical benefit (rate) of geriatric assessment in a Veterans Affairs (VA)-based oncology clinic according to the Geriatric 5Ms framework.

Abstract

e24010 Background: The geriatric assessment (GA) is a validated, multi-system assessment tool that can detect vulnerabilities often not captured with standard oncology assessments in older adult patients with cancer. The Geriatric 5Ms is a novel communication framework used to describe core competencies in geriatrics. Prior studies have shown GA integration in oncology practice can significantly reduce grade 3 or higher chemotherapy-related toxicities, falls, polypharmacy, hospital length of stay (LOS), increase completion of advanced directives, and improve quality of life measures. Despite these benefits, implementation into clinical practice has remained low. This study aimed to utilize telemedicine to integrate GA into a busy VA oncology practice. Methods: In this quality improvement study design, we enrolled adult patients aged 70 years and older with solid tumors or hematologic malignancy, either newly established or receiving active systemic treatment through an urban, academic VA oncology clinic. Patients were assigned to the intervention (GA conducted via telemedicine by a geriatric specialist) if they scored ≤14 on G8, a validated screening tool. Outcomes were compared with a historical control cohort who received usual care (no virtual GA). Reported here are the clinical benefits measured qualitatively according to the geriatric 5Ms framework. Results: Between January 1, 2022 and March 30, 2022, we enrolled 116 patients (n = 57 intervention, 59 control) from a US VA-based population. Patients had a mean age of 76.8 (SD 6.2) between both cohorts and all patients were male (100%). Among patients in the intervention cohort, all patients (100%) derived benefit in at least one element of the 5M’s framework (Mind, Mobility, Medications, Multicomplexity, and Matters Most) from GA. Based on findings from the GA, services were provided in each of the 5M’s categories in the following frequencies: multicomplexity (88%), matters most (71%), medication (58%), mentation (50%), and mobility (46%). Conclusions: Incorporating GA via telemedicine into routine oncologic care was feasible within this VA-based population of older adult patients with cancer. Further, this project led to clinic recognition as an Age Friendly Health System by the Institute for Healthcare Improvement (IHI). When routinely performed, geriatric assessment led to clinical benefit among all patients receiving the intervention according to the 5M’s framework. Future studies will compare the clinical benefits of this intervention to clinical outcomes measures such as hospital length of stay, emergency room utilization, therapy toxicity, and survival among this patient population.