Effect of Comprehensive Geriatric Assessment on Short-time Mortality in Elderly Cancer Patients

NCT ID: NCT03814213

Last Updated: 2019-04-26

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 781 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2019-01-16
• Study Completion Date: 2019-04-25

Brief Summary

Older cancer patients referred to Oncology outpatient Clinic at Aarhus University Hospital have for a period been offered Comprehensive geriatric Assessment (CGA) as part of a routine practice. Oncology Department was responsible for planning the CGA. A number of patients did however not recieve this offer as planning failed. This Group of patients will be compared to patients recieving Geriatric assessment.

Patients recieving CGA is part of a Randomised controlled study (ID: NCT02837679) comparing CGA without 90 days follow-up to CGA with 90 days of Comprehensive geriatric care.

Patients are identified from electronic medical files. Data regarding death is obtained from Medical files.

Detailed Description

Inclusion criteria:

• 70 years or more
• Cancer of the head and neck (HNC), lung (LC), upper gastro-intestinal- tract (UGI) or colo-rectal cancer (CRC)
• Referred to the Outpatient Clinic at department of oncology at Aarhus University Hospital for cancer treatment.
• Living in Aarhus, Favrskov, Odder or Skanderborg Municipalities

Exclusion:

• Referred for specialised palliative care

Patients with both newly diagnosed cancer disease and patients with a relapse of previously treated cancer disease are included. Patients qualify for participation regardless of the stage of the cancer disease and regardless if specific cancer treatment is initiated.

The oncology department is responsible for identifying patients and informing of the planned CGA.

All potential patients referred to the oncology outpatient clinic are identified by retrospective review of lists of planned consultations in the oncology department out patient clinic available in the electronic medical file approximately once a week. By this procedure patients who were not informed of the possibility of having a CGA are identified (Group1) Patients who are referred for geriatric evaluation have a complete CGA at baseline. The CGA comprises 7 instruments for assessing health: Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) for autonomy, Mini Nutritional Status (MNA) for nutritional state, Mini Mental State Examination (MMSE) for Cognitive state, Geriatric Depression Scale 15-item (GDS) for mood and Cumulative Illness Rating Scale - Geriatrics (CIRS-G) for comorbidity and number of daily medication for polypharmacy as previously published. According to CGA, patients were given a CGA-status of "fit", "vulnerable" or "frail". In order to be "fit" all of the following should be present: Independence in ADL and IADL, less than 5 daily medications, no severe comorbidity and no more than 2 well controlled comorbidities, normal cognitive ability and no indications of depression or malnutrition. Information on whether or not the multidisciplinary team initiated any individual action/advice based on the CGA in group 1 and group 2 was registered as well. Interventions initiated by the multidisciplinary team were recorded in four categories: medical changes, nutritional intervention, physical intervention or social intervention. These interventions were registered before randomization was performed Frail and vulnerable patients are offered participation in a controlled randomized study (Clinical trialsID: NCT02837679). Patients are randomly and 1:1 assigned to either: No tailored follow-up (Group 2) or 90 days tailored follow up (group 3). Randomization were performed by REDcap and allocated equally by CGA-status (frail/vulnerable), gender and index tumor site (CRC or no-CRC).

It is not possible to blind patients or the multidisciplinary team of the randomization.

Group 2 has no tailored follow up on the problems found during CGA. Group 3 has 90 days tailored follow-up on problems that were identified during CGA and problems that evolved during the follow-up period.

Tailored follow-up The tailored intervention consists of phone calls, home visits, or contact to community care-takers. A multidisciplinary team consisting of a trained geriatric nurse and a geriatrician specialist performs the follow up. The team can perform clinical investigation of patients, initiate changes in medication, or referral to further investigation. Furthermore transfusion of blood, fluids or i.v. antibiotics could be performed either at home or in the geriatric out patient clinic.

Conditions

Geriatric Assessment; Cancer

Study Design

• Observational Model Type: OTHER
• Study Time Perspective: PROSPECTIVE

Study Groups

No-CGA

Patients were not initially offered CGA due to no booking for CGA

No interventions assigned to this group

CGA alone

Patients had CGA, but no tailored follow-up upon identified problems

CGA

Intervention Type: OTHER

Multi-level Health assessment

CGA with tailored care

CGA and a tailored follow-up and care for 90 days following the CGA

CGA

Intervention Type: OTHER

Multi-level Health assessment

tailored care

Intervention Type: OTHER

Tailored care based on problems identified by CGA

Interventions

CGA

Multi-level Health assessment

Intervention Type: OTHER

tailored care

Tailored care based on problems identified by CGA

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

cancer of head and neck, lung, upper or lower gastro intestinal Canal Referred for evaluation in oncology department out patient Clinic Living in Aarhus, Odder, Favrskov or Skanderborg municipality

-

Exclusion Criteria

Referred for specialised palliative care

• Minimum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Danish Cancer Society

OTHER

Sponsor Role: collaborator

University of Aarhus

OTHER

Sponsor Role: lead

Responsible Party

Marianne Ørum

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Else M Damsgaard, DMsc

Role: STUDY_CHAIR

Aarhus University Hospital

Locations

Geriatric Department Aarhus University Hospital

Aarhus, , Denmark

Aarhus University Hospital

Aarhus, , Denmark

Countries

Denmark

Other Identifiers

90-days mortality

Identifier Type: -

Identifier Source: org_study_id