What outcome do older adults with cancer prioritize when asked?

Abstract

316 Background: The critical components of cancer care for older adults with cancer are geriatric assessment, goal setting, and skilled communication. Does defaulting a serious illness communication checklist inform preferences among outcomes from older adults with cancer? Methods: Patients ≥ 75 with a new solid tumor diagnosis were navigated into an older adult pathway. In addition to a standardized geriatric assessment (including physical fitness, function, cognition, psychological wellness, social support, caregiver distress, and nutritional status), the Serious Illness Conversation Guide (Ariadne Labs, Harvard Medical School) was used to structure the conversation around goals and values. The Outcome Prioritization Tool was used to elicit preferences for older adults. Results: 171 consecutive older adults were assessed from September 2021 to April 2023. The median age was 83 (range 75-97). Using the VES-13 survey, 11% of patients were fit, 62% vulnerable and 27% frail. Issues in cognition (12%), psychological health (22%), social support (39%), and nutrition (29%) were noted. Preserving independence was the most common treatment goal (77%) for older adults and quality of life was a common value (82%). Through shared decision-making, nearly one in three patients deviated from standard of care to align treatment with their priorities. Conclusions: Patient and caregiver value assessment is important to prioritize in cancer care. By leveraging behavioral economics, using a default pathway, and allocating appropriate resources, we were able to structure how older adults navigated through a community oncology clinic and personalized treatment plans with their goals.