Evaluating embedded geriatric care in gastrointestinal (GI) oncology program for older adults (OA): Feasibility and key learnings.

Abstract

e24015 Background: Older adults with GI cancers experience frequent interruptions to life-improving care due to emergency department (ED) or unplanned hospital visits (UHV), with estimates ranging from 34-84% for advanced disease. Geriatric assessment can predict survival, toxicity, and completion of planned therapy but has been considered cumbersome for use in oncology practice. Geriatric co-management is now standard within certain primary care and subspecialty practices at the Brigham and Women’s Hospital (BWH), and has resulted in reduced mortality at 1-year, lower incidence of delirium, and improved provider/patient satisfaction. The REACH study (Resilience and Equity in Aging, Cancer, and Health) is a type III hybrid implementation mixed methods study that evaluates the ability of geriatric consultation to improve quality of life and reduce ED/UHV for pre-frail and frail OA diagnosed with GI cancer. Methods: We reviewed early data from the REACH study based in the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute (DFCI) between Jan. 2022–Jan. 2023. Data included REACH-eligible patients scheduled for a new consult visit, OA patients continuing care at DFCI, percentage of patients consented to participate, and percentage of consented patients who completed the frailty questionnaire (EFA). Results: As of 1/31/2023, a total of 815 OA patients age 70+ were screened initially eligible. Consented patients completed the REACH EFA. Among the 815 patients initially eligible, 73.8% of OA patients aged 70-74 continued care at DFCI, along with 74.7% of patients age 75-79, and 73.5% of patients age 80-84. For patients 85 or older, 82.7% of patients continued their oncology care at DFCI. Patients who screened ineligible or declined to participate were due to either not continuing care at DFCI, preferred language other than English/Spanish, or initiating hospice care. From Jan. 2022 to Jan. 2023, n = 30 consented to participate with a 90% completion rate of the full EFA questionnaire (n = 27/30). Conclusions: Data for the REACH study is ongoing. We are now transitioning to a clinical program where consent is no longer needed to complete the REACH EFA questionnaire. DFCI has pivoted to EFA questionnaire being standard of care for OA patients due to its acceptability and importance. Future program efforts will improve patient language access and expand to additional DFCI regional sites around New England to ensure a more diverse population and provide tailored support for those patients who have a higher level of frailty and more complex needs throughout their cancer care journey. Clinical trial information: NCT04674267 .