Geriatric Assessment Domains Research Articles

Predicting frailty domain impairments and mortality with the Hospital Frailty Risk Score among older adults with cancer: the ELCAPA-EDS cohort study.

Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark. This retrospective, linkage-based study included patients aged ≥70years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016-2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10days, 30-day readmission, and mortality. Among 587 patients included (median age 82years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS>5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment. Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains.

Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment.

Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment. This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person's Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities). Among 616 participants, mean number of meds was 6 (range 0-24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00-1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04-1.40) and falls (aRR, 1.93; 95% CI, 1.49-2.51). In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients. ClinicalTrials.gov Identifier: NCT02054741. Registered 01-31-2014.

Taking care of inpatients with fragility hip fractures: the hip-padua osteosarcopenia (Hip-POS) fracture liaison service model.

Osteoporotic fragility fractures (FF), particularly those affecting the hip, represent a major clinical and socio-economic concern. These fractures can lead to various adverse outcomes, which may be exacerbated by the presence of sarcopenia, especially among older and frail patients. Early identification of patients with FF is crucial for implementing effective diagnostic and therapeutic strategies to prevent subsequent fractures and their associated consequences. The Hip-POS program, implemented at Azienda Ospedale-Università Padova, is a Fracture Liaison Service (FLS) program to evaluate patients aged > 50years old admitted with fragility hip fractures, involving an interdisciplinary team. After the identification of patients with hip fractures in the Emergency Department, a comprehensive evaluation is conducted to identify risk factors for further fractures, and to assess the main domains of multidimensional geriatric assessment, including muscle status. Patients are then prescribed with anti-fracture therapy, finally undergoing periodic follow-up visits. During the first five months, a total of 250 patients were evaluated (70.4% women, median age 85years). Following assessment by the Hip-POS team, compared to pre-hospitalization, the proportion of patients not receiving antifracture therapy decreased significantly from 60 to 21%. The prescription rates of vitamin D and calcium increased markedly from 29.6% to 81%. We introduced the Hip-POS program for the care of older adults with hip fractures. We aspire that our model will represent a promising approach to enhancing post-fracture care by addressing the multifactorial nature of osteoporosis and its consequences, bridging the gap in secondary fracture prevention, and improving patient outcomes.

Geriatric assessment and management with question prompt list using a web-based application for elderly patients with cancer to communicate aging-related concerns: A randomized clinical trial (J-SUPPORT 2101 study).

1511 Background: Older adults with cancer have aging-related physical and psychosocial problems that should be fully shared with their oncologists. Geriatric assessment (GA) can assess these aging-related problems and guide management. Communication support might also facilitate implementation of GA-guided management (GAM). We conducted this single-blind, parallel-group, multicenter, randomized controlled trial to evaluate the efficacy of a program providing GAM recommendation and communication support between older Japanese patients with cancer and their oncologists. Methods: Eligibility criteria were age≥70 years, advanced or recurrent cancers of gastrointestinal origin, referral to one of the two institutions for first- or second-line systemic therapy, and impairment in at least one GA domain as assessed using a web-based application at baseline. In the intervention group, GAM recommendations and question prompt list (QPL) were provided to patients by trained intervention providers to be shared with their oncologists at the first outpatient visit after randomization. Over 5 months after the initial intervention, implementation of GAM recommendations was reviewed monthly by the intervention providers with the patients and their oncologists. Patients in the control group received usual care. The primary endpoint was the number of conversations about aging-related concerns at the first visit. The quality of conversations was assessed in terms of the number of conversations in which stated concerns were acknowledged and considered further by the oncologist and the number of conversations in which acknowledged concerns motivated implementation of GAM recommendations. Results: A total of 215 patients (99 women, 116 men; median age 75 [range 70-88] years) were randomized (n=108/107 in the intervention/control group) between September 2021 and September 2023. There were no differences between two groups in patient background characteristics including the prevalence of GA impairments. The number of conversations about aging-related concerns was significantly higher in the intervention group than in the control group (mean [SD] 2.95 [1.53] vs. 1.90 [1.49], p<0.0001). The number of high-quality conversations and number of conversations about GAM recommendations were also significantly higher in the intervention group than in the control group (1.73 [1.40] vs. 1.12 [1.16], p=0.001; 0.57 [0.74] vs. 0.28 [0.47], p=0.001, respectively). Conclusions: Our program providing GAM recommendations and communication support successfully facilitated aging-related communications between patients and their oncologists. We will further examine whether facilitated communication leads to actual implementation of GAM and improved patient health outcomes in a follow-up study. Clinical trial information: UMIN000045428 .

Implementing a mutidisciplinary approach for older adults with cancer: Challenges and achievements in a geriatric oncology program in Sao Paulo, Brazil.

e13769 Background: Treating an older adult with cancer is complex and requires multidisciplinary effort. Multiple studies demonstrate the benefits of timely integration of Geriatric Oncology (GO) with routine oncologic care. Despite this growing body of evidence, there are very few cancer centers around the world that have a dedicated GO program, notably in low- and middle- income countries (LMIC). The objective of this abstract is to describe the first year of the GO program in a private oncology center in São Paulo, Brazil. Methods: As an effort of oncologists, geriatricians and nurses, the team built a consultative model with a nurse performing the G8 triage score to every cancer patient aged ≥ 70 years. For those with a G8 less than 14 points, a comprehensive geriatric assessment (CGA) was performed. The results of the CGA were than provided as a report to the treating physician and all the members of the multidisciplinary team, so that a geriatric assessment (GA) driven intervention could be planned. The patients were then followed for 3, 6, and 12 months to detect falls, emergency rooms visits, hospitalizations, and death. Results: From January 2023 to January 2024, 110 patients with a median age of 79 were evaluated, with 57% having a G8 less than 14. 70 patients we submitted to a CGA. The majority of the tumors were gastrointestinal (30%), lung (20%) and genito-urinary (17%). Regarding the GA domains: 70% of the patients had a possible or probable cognitive impairment by the 10-point cognitive screener; 53% mild psychological distress by PHQ-4 Screening Tool; 47% showed important reduction in hand grip strength scale calling the attention to sarcopenia; 48% were found to be at nutritional risk and 42% were classified as malnourished at the mini-nutritional assessment; polypharmacy was detected in 67% of the patients. Despite these findings, 78% of the patients we classified as ECOG 0 or 1. After GA driven interventions, at 3 and 6 months follow up, 88% of the patients remained with no falls, with a mild rate of hospitalizations (40%) and a low rate of treatment discontinuation (15%). By the end of 6 month follow up, 24% of the patients have died. Conclusions: Geriatric conditions such as functional impairment are common and frequently unrecognized or inadequately addressed in older adults with cancer. Identifying geriatric conditions by performing a GA can help the health team to manage these conditions and provide better oncology care.

Geriatric assessment in older patients with non-small cell lung cancer: Insights from a cluster-randomized, phase III trial—ENSURE-GA study (NEJ041/CS-Lung001).

1502 Background: To determine optimal treatment in older cancer patients, it is recommended to conduct a geriatric assessment (GA) before chemotherapy. The ENSURE-GA study, which focused on patients aged 75 and older with non-small cell lung cancer (NSCLC), reported that the implementation of GA not only enhanced patient satisfaction with regards to communication with their physicians, but also improve the patients’ quality of life. Additionally, we assessed whether GA could improve overall survival and serve as a predictor for severe adverse events. Methods: Patients aged ≥75 with NSCLC who were unable undergo radical treatment were enrolled. All patients underwent a standardized GA before treatment. The participating institutions were cluster-randomized into either intervention group or control group. For the intervention group, GA summaries and recommendations for GA-guided interventions were provided to guide physicians in selecting treatments and interventions. The control group did not provide physicians with GA summaries. Geriatric 8 (G8) and CARG scores were calculated at enrollment, and we investigated whether adverse events during a 3-month follow-up could be predicted. Results: Between 2019 and 2022, 1,021 patients were enrolled from 78 institutions in Japan. No significant differences were observed in patient characteristics or for GA domains between intervention and control groups. Additionally, there were no significant differences seen in 1-year overall survival (20.7m vs 18.8m, p = 0.414), or the incidence of grade 3 or higher adverse events in patients treated with medical treatment (36.8% vs 38.1%, p = 0.732). The ROC curve for G8 regarding the occurrence of grade 3 or higher adverse events in cases receiving cytotoxic chemotherapy yielded an AUC of 0.525, indicating no discriminatory ability. Furthermore, there was no difference in the incidence of adverse events between low-risk and high-risk patients based on the CARG score. Conclusions: The implementation of GA and interventions based on its results enhances patient satisfaction. However, additional studies are needed before incorporating GA into an adverse event prediction system. Developing risk scoring tools specific to cancer types and races may prove useful. Clinical trial information: UMIN0000037590 .

Exploring the Language Used to Describe Older Patients at Multidisciplinary Cancer Conferences.

Older adults with cancer often present with distinct complexities that complicate their care, yet the language used to discuss their management at multidisciplinary cancer conferences (MCCs) remains poorly understood. A mixed methods study was conducted at a tertiary cancer centre in Toronto, Canada, where MCCs spanning five tumour sites were attended over six months. For presentations pertaining to a patient aged 75 or older, a standardized data collection form was used to record their demographic, cancer-related, and non-cancer-related information, as well as the presenter's specialty and training level. Descriptive statistics and thematic analysis were employed to explore MCC depictions of older patients (n = 75). Frailty status was explicitly mentioned in 20.0% of presentations, but discussions more frequently referenced comorbidity burden (50.7%), age (33.3%), and projected treatment tolerance (30.7%) as surrogate measures. None of the presentations included mentions of formal geriatric assessment (GA) or validated frailty tools; instead, presenters tended to feature select GA domains and subjective descriptions of appearance ("looks to be fit") or overall health ("relatively healthy"). In general, MCCs appeared to rely on age-focused language that may perpetuate ageism. Further work is needed to investigate how frailty and geriatric considerations can be objectively incorporated into discussions in geriatric oncology.

Primary Treatment Modification and Treatment Tolerability Among Older Chemotherapy Recipients With Advanced Cancer

Older adults with advanced cancer are less likely to tolerate treatment with cytotoxic chemotherapy compared with younger patients due to their aging-related conditions. Hence, oncologists sometimes opt to employ primary treatment modifications (deviation from standard of care) during the first cycle of chemotherapy. To examine the association between primary treatment modification and treatment tolerability in older adults with advanced cancer who were starting new palliative chemotherapy regimens. This cohort study was a secondary analysis of the GAP70+ (Geriatric Assessment Intervention for Reducing Toxicity in Older Patients with Advanced Cancer) trial, which was conducted between July 2014 and March 2019. The GAP70+ trial included patients aged 70 years or older who had advanced (ie, incurable) cancer, had 1 or more geriatric assessment domain impairments, and planned to start a new palliative chemotherapy regimen. Data analysis was conducted in November 2022. Receipt of standard-of-care chemotherapy regimens vs primary treatment modification defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials (eg, primary dose reduction, schedule change). Tolerability outcomes were assessed within 3 months of treatment. These outcomes included the following: (1) any grade 3 to 5 toxic effect, according to the National Cancer Institute Common Terminology Criteria for Adverse Events; (2) patient-reported functional decline, defined as the development of worse dependency in activities of daily living using scale scores; and (3) a composite adverse outcome (an end point that combined toxic effects, functional decline, and 6-month overall survival). Multivariable cluster-weighted generalized estimating equation models examined the association between primary treatment modification and outcomes adjusting for covariates. This study included 609 patients with a mean (SD) age of 77.2 (5.2) years; more than half (333 [54.7%]) were men. Race and ethnicity was available for 607 patients: 39 (6.4%) were Black, 539 (88.5%) were non-Hispanic White, and 29 (4.8%) were of other race or ethnicity. Nearly half (281 [46.1%]) received a primary modified treatment regimen. The most common cancer types were gastrointestinal cancer (228 [37.4%]) and lung cancer (174 [28.6%]). In multivariable analysis, primary treatment modification was associated with a reduced risk of grade 3 to 5 toxic effects (relative risk [RR], 0.85 [95% CI, 0.77-0.94]) and functional decline (RR, 0.80 [95% CI, 0.67-0.95]). Patients who received primary treatment modification had 32.0% lower odds of having a worse composite adverse outcome (odds ratio, 0.68 [95% CI, 0.48-0.97]). In this cohort study, primary treatment modification was associated with improved tolerability of chemotherapeutic regimens among older adults with advanced cancer and aging-related conditions. These findings may help optimize cancer treatment dosing in older adults with advanced cancer and aging-related conditions.

Associated factors with domains of comprehensive geriatric assessment among older post-stroke patients

This is a cross-sectional study conducted on 137 post-stroke patients aged ≥ 60 years old treated at the National Geriatric Hospital to explore some factors related to domains of comprehensive geriatric assessment (CGA). The components of CGA assessed were medical status (nutrition; urinary incontinence, frailty, visual and hearing ability), functional status (Barthel index, instrumental activity daily living, risk of fall) and neuropsychological status (cognition and depression). Patients ≥ 70 years old had a prevalence of malnutrition/risk of malnutrition, cognitive impairment, urinary incontinence, and frailty syndrome significantly higher than patients under 70 years old (p<0.05). Post-stroke patients with hemiplegia had significantly higher dependency, cognitive impairment, depression, urinary incontinence, frailty syndrome, and hearing loss than patients without hemiplegia (p<0.05). There was no statistically significant difference between gender, stroke classification, post-stroke duration, and the number of strokes and domains of CGA in older post-stroke patients. In summary, this study showed that advanced age and hemiplegia were significantly associated with some CGA domains.

Defining an Abnormal Geriatric Assessment: Which Deficits Matter Most?

At present, there is no clear definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology. Various threshold numbers of abnormal GA domains are often used, but how well these are associated with treatment plan modification (TPM) and whether specific GA domains are more important in this context remains uncertain. A retrospective review of the geriatric oncology clinic database at Princess Margaret Cancer Centre in Toronto, Canada, including new patients seen for treatment decision making from May 2015 to June 2022, was conducted. Logistic regression modelling was performed to determine the association between various predictor variables (including the GA domains and numerical thresholds) and TPM. The study cohort (n = 736) had a mean age of 80.7 years, 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability (≥3). In the univariable analysis, the best-performing threshold number of abnormal domains based on area under the curve (AUC) was 4 (AUC 0.628). The best-performing multivariable model (AUC 0.704) included cognition, comorbidities, and falls risk. In comparison, the multivariable model with the sole addition of the threshold of 4 had an AUC of 0.689. Overall, an abnormal GA may be best defined as one with abnormalities in the domains of cognition, comorbidities, and falls risk. The optimal numerical threshold to predict TPM is 4.

Assessment of geriatric and clinical domains for development and validation of a novel nomogram to predict the prognosis of older patients with breast cancer: a real-world retrospective cohort study

BackgroundBreast cancer is a relatively heterogeneous disease in the older population. Survival in older breast cancer patients is not only affected by tumor-related factors, but also by geriatric assessment domains. How tumor clinical factors and geriatric factors specifically affect the survival rate of older patients and how to combine these two factors to predict the risk of death in older patients with breast cancer remain clinical questions to be addressed.MethodWe used the Peking Union Medical College Hospital database to identify older patients (≥65 years) who were newly diagnosed with breast cancer between January 2013 and December 2019. Of the 641 eligible patients, we retrospectively analyzed the clinical and geriatric data of 556 patients who formed our study population. The primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors and construct a nomogram to predict the 1-, 3-, and 5-year survival rates. The performance of the constructed nomogram was evaluated using calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA).ResultsMultivariate Cox regression analysis revealed seven independent prognostic factors associated with OS in older patients with breast cancer: age, tumor stage, lymph node stage, intrinsic molecular subtype, functional status, comorbidities, and psychological state. Nomogram based on these seven factors yielded excellent performance, with area under the ROC curve (AUROC) of 0.748. Similarly, the nomogram for BCSS had an AUROC of 0.760. Moreover, the calibration curve and DCA revealed good predictive accuracy between the actual and predicted probabilities.ConclusionIndependent prognostic factors for OS and BCSS in older patients with breast cancer in China were determined in our study. A novel nomogram for predicting the 1-, 3-, and 5-year OS and BCSS in this patient population was developed and validated. The nomogram exhibited good accuracy, indicating its potential for clinical decision making and improving outcomes.

Dynamic changes in physical function during intensive chemotherapy affect transplant outcomes in older adults with AML.

Intensive chemotherapy (IC) can affect all geriatric assessment (GA) domains in older adults with acute myeloid leukemia (AML), but data on the effects of these changes on transplant outcomes are lacking. Therefore, we prospectively assessed the prognostic role of GA domains at diagnosis and allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 51 patients with AML aged ≥60 years who achieved complete remission after IC. We performed both baseline and pre-allo-HSCT GA; moreover, physical function, including a short physical performance battery (SPPB), cognitive function, psychological function, nutritional status, and social support were examined. All GA domains showed dynamic changes between the two time points. The directions of change were statistically significant for social support, self-reported physical and psychological functions, and distress, but not for nutritional status, cognitive function, or physical function. Among all GA domains at each time point, only poor physical function and its submaneuvers at diagnosis but not at allo-HSCT were significantly associated with inferior survival. In particular, since the direction of change varied between patients, we found that patients whose physical function improved before allo-HSCT were more likely to survive longer than those with persistently impaired SPPB (55.6% vs. 28.6%, p=0.268). Finally, persistent impairment in SPPB (28.6% vs. 65.9%, p=0.006), tandem stand (0% vs. 63.3%, p=0.012), sit-and-stand (41.2% vs. 70.6%, p=0.009), and gait speed (38.5% vs. 68.4%, p=0.027) further strongly predicted inferior survival. This study showed that IC courses can induce dynamic changes in different directions in the GA domains of each patient and that changes in objectively measured physical function can predict transplant outcomes.

Correlation of the Geriatric Assessment with Overall Survival in Older Patients with Cancer

AimsGlobal guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients. Materials and methodsThis was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail. ResultsBetween June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65–73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2–not reached) months, compared with 11.2 (10.1–12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41–0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41–0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0–1 group was 33.0 months (95% confidence interval 24.31–not reached) in the fit group versus 14.4 months (95% confidence interval 12.25–18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34–0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52–0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48–0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49–0.91, P = 0.011). DiscussionThe geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.

SIOG2023-5-P-362 - Anxiety is associated with impaired geriatric assessment domains among adults with colorectal cancer

SIOG2023-5-P-362 - Anxiety is associated with impaired geriatric assessment domains among adults with colorectal cancer

Factors associated with the evaluation of geriatric assessment (GA) domains by oncology specialists in Mexico.

The use of geriatric assessment (GA) by oncology specialists in Mexico is low. We aimed to explore factors associated with the evaluation of individual GA domains by Mexican oncology specialists. We performed an exploratory analysis of a sequential explanatory mixed-methods study consisting of an online cross-sectional survey of Mexican oncology specialists and follow-up interviews on the use of GA in cancer care. For each GA domain, we performed multivariable logistic regression analyses with the frequency of evaluation of the domains as the dependent variable (dichotomised as never/rarely/sometimes versus most of the time/always). A p-value <0.05 was considered significant. Qualitative data from the interviews were analysed inductively. Of 196 respondents, 62% were male, 50% were surgical oncologists, 51% took care of >10 patients per day and 61.7% had access to a geriatrician. Self-perceived confidence in managing common geriatric conditions was associated with the evaluation of specific GA domains. For instance, self-perceived confidence in managing dementia (OR 2.72; 95% CI 1.42-5.51, p = 0.008) was associated with cognition evaluation, while for evaluation of falls, self-perceived confidence in evaluation of falls (OR 6.31; 95% CI 3.19-12.46, p < 0.001) was significantly associated. Follow-up interviews showed quality and appropriateness of evaluations may not be ideal: in many cases, physicians do not use guideline-recommended tools. For example, evaluation of cognition is commonly performed through non-validated methods which may miss the detection of patients with an impairment in this domain, partly due to limitations in knowledge and time to use recommended tools. In conclusion, self-perceived confidence in evaluating and managing common situations in older adults was associated with the evaluation of GA domains as part of everyday practice in a sample of oncology specialists in Mexico. This analysis supports the use of educational interventions to boost knowledge and confidence regarding the proper use of validated GA tools among oncology specialists.

Influence of age on pharmacokinetics of capecitabine and its metabolites in older adults with cancer: a pilot study.

Capecitabine is an oral chemotherapy prodrug of 5-fluorouracil (5-FU) with unpredictable toxicity, especially in older adults. The aim of this study was to evaluate the pharmacokinetics (PK) of capecitabine and its metabolites in younger adults (< 70years) and older adults (≥ 70years) receiving capecitabine for solid cancer. Eligible participants receiving capecitabine had 2 venous samples collected on day 14 of cycle 1 and cycle 2 of their treatment. Capecitabine and metabolite concentrations were determined using liquid chromatography with tandem mass spectrometry. A Bayesian estimation approach was used to generate individual estimates of PK parameters for 5-FU. A linear mixed-effect analysis of variance (ANOVA) model was used to compare dose-normalised log-transformed PK parameters between age groups. Correlations were determined by linear regression and logistic regression analyses. Of the total 26 participants, 58% were male with a median age of 67years (range, 37-85) with 54% aged < 70years and 46% aged ≥ 70years. Participants aged ≥ 70years, compared to those aged < 70years, had a greater 5-FU exposure based on area under the concentration-time curve (AUC) of 17% (90% CI 103-134%; 0.893 vs. 0.762mg h/L) and 14% increase in maximal concentration, Cmax (90% CI 82.1-159%; 0.343 vs. 0.300mg/L). The 5-FU Cmax was positively associated with time up and go (TUG) (Pearson's correlation 0.77, p = 0.01), but not other geriatric assessment domains or severe toxicity. 5-FU exposure was significantly increased in older adults compared to younger adults receiving equivalent doses of capecitabine, and is a possible cause for increased toxicity in older adults.

Defining an abnormal geriatric assessment for older adults with cancer: Which deficits matter most?

12039 Background: At present, there is no universal, objective, and evidence-based definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology (GO). In the literature, a threshold number of abnormal GA domains (ranging from 1-4) is often used to define an abnormal GA. However, it is not well-established whether having a specific number of abnormal domains more frequently leads to treatment plan modification (TPM), a key goal of GA, or if particular domains have a greater impact on TPM. The primary objectives of this study are: (1) to determine how well the current definitions of an abnormal GA predict TPM following GA, and (2) to identify particular GA domains associated with TPM. Methods: A retrospective review of the GO clinic database at Princess Margaret Cancer Centre was conducted. All new patients seen in clinic from May 22, 2015 to June 10, 2022 who met the following criteria were included: (1) referred for treatment decision making, (2) received a complete GA, and (3) had a proposed oncologic treatment plan. Demographic, oncologic, and GA-domain variables were extracted. Univariate and multivariate logistic regression modelling was conducted using SPSS to determine each variable’s association with TPM; age, sex, frailty (VES-13) score, and treatment intent were included in all multivariate models. Area under the curve (AUC) was calculated for each model. Results: The study cohort (n = 736) had a mean age of 80.7 years (61-100), 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability. In univariate analysis, age, VES-13 score, disease stage, treatment intent, all GA domains (except Medication Optimization and Social Supports), and all threshold numbers of abnormal domains (except 1 and 7) were significantly associated (p-value &lt; 0.050) with TPM. The best-performing threshold number of abnormal domains in univariate analysis was 4 (AUC 0.628). Overall, the best-performing multivariate model based on AUC was the model containing all 6 significant GA domains (AUC 0.710). In this model, age, treatment intent, Comorbidities, Falls Risk, and Cognition were independently associated with TPM (p-value &lt; 0.05). The multivariate model with a threshold of 4 abnormal domains alone had an AUC of 0.689 and age, VES-13 score, treatment intent, and the threshold were independently associated with TPM. Of the models which included a single GA domain plus the threshold, the models with Comorbidities and Cognition performed best, having AUCs of 0.699 and 0.700, respectively. Conclusions: Overall, our results suggest that an abnormal GA (leading to TPM) may be best defined as one with abnormalities in the domains of Comorbidities, Falls Risk, and Cognition. In terms of a strictly numerical threshold, a GA may be best defined as abnormal if at least 4 GA domains are abnormal. When at least 4 GA domains are abnormal, abnormalities in Comorbidities and Cognition appear to best predict TPM.

Feasibility of integrating geriatric oncology and palliative care assessment into the routine care of older adults in a community setting.

e24024 Background: Emerging data support the value of geriatric assessment (GA) and palliative care (PC) domains in determining treatment for older adults with cancer. Limited data exist on the ability to integrate GA and PC in a community oncology clinic. The objective of this study was to determine the feasibility of integrating GA and PC screening in the community. Methods: Patients ≥ 75 were eligible. The GA included a health care provider assessment of performance status, cognitive function, functional status, psychological state, social support, and nutritional status. PC assessment included ESAS questionnaire, patient goals and values, advance care plans, and caregiver distress. Results: From September 2021 to Jan 2023, 131 consecutive older adults were assessed in one community clinic in the State of New Jersey, a satellite of the University of Pennsylvania. The median age was 82 (range 75-97). Using the VES-13 survey, 11% of patients were fit, 60% vulnerable and 29% frail. Issues were noted in cognition (11%), psychological state (27%), social support (38%), and nutrition (26%). The majority of patients prioritized quality of life over time (73%) and maintenance of independence was often cited as the most important goal (62%). Fewer than half of patients had formal advance directives (42%). 32% of the time, the final plan deviated from standard of care to align with patient/caregiver values. Conclusions: Integration of GA and PC is feasible in the community oncology setting. Further study is planned to evaluate the impact on patient and caregiver outcomes, and to standardize assessment for routine care across all Penn Medicine clinics.

Identifying sources and mechanisms for missed opportunities in discussing cognition and capacity among older adults with advanced cancer, their caregivers, and physicians.

e24019 Background: Impaired cognition increases the risk of treatment-related toxicity and adverse cancer outcomes. Thus, communication about cognition is essential for informed decision making, particularly for patients with abnormal cognitive screening results (e.g. Mini-Cog). We aimed to qualitatively explore missed opportunities in discussing cognition and capacity in oncology clinical encounters for patients with an impaired Mini-Cog score. Methods: This secondary analysis examined audio recordings of clinical encounters from a nationwide, multi-center, cluster-randomized trial (NCT02054741; PI: Mohile; funding NCI UG1CA189961). Eligible patients were age 70 years or older with at least one geriatric assessment (GA) domain impairment, either receiving or considering cancer treatment for incurable cancer. Patients were randomly assigned to usual care or GA-guided communication intervention (GA summary with recommendations was provided to patient, caregiver, oncologist). Clinical encounters in both arms were audio-recorded and transcribed. A sample size of 75 patients with impaired Mini-Cog was utilized to meet thematic saturation. Transcribed interviews were open-coded by 2-4 independent coders using a constant comparative method to simultaneously code and analyze for thematic elements. Missed opportunity for cognitive or capacity conversations was identified when a cognitive or capacity concern was mentioned but not acknowledged and/or addressed by other participants in the conversation, or when concerns were alluded to but not described in sufficient detail. Results: A total of 74 patients were evaluated with mean age 78.7 years (SD 6.0). The majority were male (53.3%), white (86.7%), non-Hispanic (100%), with gastrointestinal (26.7%) or lung (25.3%) cancer. Overall, 48 missed opportunities were identified across the 75 clinical encounters (cognition 39 [81.3%]; capacity 9 [18.8%]); oncologists, patients, and caregivers all contributed as sources of missed opportunities to discuss cognition/capacity (63%, 24%, 13% respectively). Mechanistically, when oncologists were the source of the missed opportunity, it was due to: 1) a lack of response to either caregiver or patient’s concern, or 2) not allowing space for the patient or caregiver to elaborate or clarify. When patients were the source of a missed opportunity, it was due to: A) cognitive impairment preventing meaningful conversation, B) minimization or deflection of concern by the patient, or C) lack of engagement in conversation. Conclusions: We identified several underlying mechanisms of missed opportunities in discussing cognition/capacity in oncology clinical encounters. Discussing cognition/capacity in the context of oncology is critical and future work should develop interventions to enhance communication about cognition. Clinical trial information: NCT02054741 .

Peaceful acceptance of illness among older adults with cancer.

12045 Background: Greater illness acceptance is associated with lower levels of psychological distress and higher rates of completion of advance care planning in adults with advanced cancer. However, studies on factors associated with illness acceptance among older adults with advanced cancer are limited and historically have not explored its relationship with caregiver or physician characteristics, despite the important role caregivers and oncologists play in patient illness acceptance. We aimed to evaluate the associations of patient, caregiver, and physician-related factors with illness acceptance among older adults with cancer. Methods: We utilized data from a national geriatric assessment cluster-randomized trial (NCT 02054741; PI: Mohile; funding NCI UG1CA189961). We recruited patients aged 70 years or over with stage III or IV incurable solid tumors or lymphoma and at least one geriatric assessment domain impairment as well as their caregivers. Illness acceptance was assessed using the 5-item Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire (range 5-20). Higher PEACE score indicates greater illness acceptance. Multiple linear regression was used to assess the associations of patient, caregiver, and physician-related variables with PEACE. Variables included patient sociodemographic factors, geriatric assessment variables, and estimated life expectancy; caregiver sociodemographic variables, anxiety, depression, and physical function; and oncologist years in practice and comfort with geriatrics. Results: We included 333 patient-caregiver dyads; mean age (SD) of patients and caregivers, respectively, were 76.8 (5.4) and 66.6 (12.1). Approximately 27%, 26%, and 16% of patients had lung, gastrointestinal, and genitourinary cancers, respectively. Mean PEACE score was 17.4 (2.5), indicating relatively high illness acceptance (Table). On regression analysis, patient psychological impairment domain (including both anxiety and depression) (B=-0.89; p&gt;0.01), patient’s lower estimated life expectancy (≤1 vs. &gt;5 years, B=-1.19, p=0.02), and lower caregiver education attainment (≤high school vs. college; B=-0.86; p&lt;0.01) were associated with a lower illness acceptance. No physician variables were associated with PEACE. Conclusions: A better understanding of illness acceptance and its associated factors can facilitate patient-caregiver dyadic interventions to improve illness acceptance. [Table: see text]