Geriatric and Oncological Evaluation With Technology for Holistic Healthcare Management for Older Multimorbid Patients.

NCT ID: NCT05423808

Last Updated: 2024-08-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-30

Study Completion Date

2024-08-08

Brief Summary

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The GerOnTe TWOBE study aims to evaluate the effectiveness of the GerOnTe intervention, consisting of a renewed, patient-centred, care pathway coordinated by an APN and supported by a Health Professional Consortium and IC Technology, compared to the current standard of care in the eight different Belgian and Dutch hospitals.

Detailed Description

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The GerOnTe TWOBE study aims to evaluate the effectiveness of the GerOnTe intervention, consisting of a renewed, patient-centred, care pathway coordinated by an APN and supported by a Health Professional Consortium and IC Technology, compared to the current standard of care in the eight different Belgian and Dutch hospitals. The GerOnTe project consists of two identical trials in two different European geographical areas, FRONE in France and TWOBE in Belgium and the Netherlands. The goal of two identical trials is to take into account the role of health care contexts in the implementation, effectiveness and efficiency of the GerOnTe intervention. A stepped wedge randomized controlled trial, where the randomized clusters will be participating hospitals, will be conducted in eight academic and general hospitals in total with a follow-up at 3, 6, 9 and 12 months after study inclusion. Patients will be recruited in all participating hospitals in the period between the cancer diagnosis and the treatment decision.

Conditions

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Geriatrics Medical Oncology Critical Pathways Digital Technology

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

stepped wedge randomized controlled trial (cross-over type)
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Intervention group

Patients in the intervention group will be part of a renewed care pathway supported by digital tools.

Group Type EXPERIMENTAL

Health Professional Consortium

Intervention Type OTHER

In the intervention group, the renewed, patient-centred care pathway will be coordinated by the Advanced Practice Nurse (APN) and will be supported by digital technology. The intervention aims to increase the involvement of the patient in the treatment decision process, to provide comprehensive care through the quarterly meeting of all professionals involved in the care of the patient during a Health Professional Consortium (HPC) and to support patient empowerment by supporting self-management by using digital tools.

Holis Dashboard - Holis Patient App

Intervention Type DEVICE

In the intervention group, the renewed, patient-centred care pathway will be coordinated by the Advanced Practice Nurse (APN) and will be supported by digital technology. The intervention aims to increase the involvement of the patient in the treatment decision process, to provide comprehensive care through the quarterly meeting of all professionals involved in the care of the patient during a Health Professional Consortium (HPC) and to support patient empowerment by supporting self-management by using digital tools.

Control group

Patients in the control group will receive standard of care, specific to the hospital where the patient is being treated.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Health Professional Consortium

In the intervention group, the renewed, patient-centred care pathway will be coordinated by the Advanced Practice Nurse (APN) and will be supported by digital technology. The intervention aims to increase the involvement of the patient in the treatment decision process, to provide comprehensive care through the quarterly meeting of all professionals involved in the care of the patient during a Health Professional Consortium (HPC) and to support patient empowerment by supporting self-management by using digital tools.

Intervention Type OTHER

Holis Dashboard - Holis Patient App

In the intervention group, the renewed, patient-centred care pathway will be coordinated by the Advanced Practice Nurse (APN) and will be supported by digital technology. The intervention aims to increase the involvement of the patient in the treatment decision process, to provide comprehensive care through the quarterly meeting of all professionals involved in the care of the patient during a Health Professional Consortium (HPC) and to support patient empowerment by supporting self-management by using digital tools.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Age ≥ 70 years old,
3. Estimated life expectancy greater than 6 months,
5. Patients must be willing and able to comply with study procedures,
6. Voluntarily signed and dated written informed consents prior to any study specific procedure,
7. QLQ-C30 Quality of Life Questionnaire fully completed at baseline, before inclusion.



* No prior treatment for the current breast cancer.
* All 3 criteria required:

* Clinical staging: cT2-3-4 Nany, or cTany N1-2-3,
* The cancer specialist considers\* surgery,
* The cancer specialist considers\* radiotherapy and/or chemotherapy. 8.2. Metastatic breast cancer (M1): Both criteria required:
* The cancer specialist considers\* chemotherapy or PARP-inhibitors or mTOR-inhibitors / PIK3CA inhibitors; Previous endocrine therapy +/- CDK4/6 inhibitors is allowed,
* The patient received maximum 1 prior line of chemotherapy for metastatic disease.

\*'consider' implies that this treatment may be a treatment option for this patient in this particular setting. If at a later point, a different treatment choice is made, the patient remains eligible.

* No prior therapy for the current tumour in the recruiting hospital.
* At least one of the 3 criteria required:

\- The cancer specialist considers\* surgery,

\- The cancer specialist considers\* radiotherapy,

\- The cancer specialist considers\* chemotherapy. 9.2. Metastatic colorectal cancer (M1):
* The cancer specialist considers\* first line systemic therapy and/or radiotherapy (+/- surgery). No previous chemotherapy allowed except adjuvant/perioperative chemotherapy stopped for more than 12 months.

\*'consider' implies that this treatment may be a treatment option for this patient in this particular setting. If at a later point, a different treatment choice is made, the patient remains eligible.

* No prior therapy for the current tumour in the recruiting hospital.
* At least one of the 3 criteria required:

* The cancer specialist considers\* surgery (patients considered for treatment with percutaneous thermoablation alone are not eligible),
* The cancer specialist considers\* radiotherapy (except SBRT),
* The cancer specialist considers\* systemic therapy. Possible systemic therapies are chemotherapy and/or immune therapy and/or targeted therapy. Patients only considered\* for monotherapy with anti-EGFR TKI or somatostatin analog are not eligible.

10.2. Metastatic lung cancer (M1):

* The cancer specialist considers\* first or second line systemic therapy. Possible systemic therapies are chemotherapy and/or immune therapy and/or targeted therapy. Patients only considered\* for monotherapy with anti-EGFR TKI or somatostatin analog are not eligible.

\*'consider' implies that this treatment may be a treatment option for this patient in this particular setting. If at a later point, a different treatment choice is made, the patient remains eligible.

* First diagnosis M0 prostate cancer (no therapy received yet for prostate cancer): at least one of the 2 criteria required:

\- The cancer specialist considers\* radiotherapy,
* The cancer specialist considers\* hormone therapy (ADT +/- combination Abiraterone and Prednisone).
* Salvage treatment M0 prostate cancer (received prior surgery at least 6 months before):

* The cancer specialist considers\* radiotherapy (+/- ADT).
* Non-metastatic castration resistant prostate cancer:

* The cancer specialist considers\* treatment intensification (ADT + Enzalutamide or Apalutamide or Darolutamide).

11.2. Metastatic prostate cancer (M1): • The cancer specialist considers\* treatment with Abiraterone or Enzalutamide or Apalutamide, or Docetaxel or Cabazitaxel or PARP-inhibitors or Lutetium PSMA.

\*'consider' implies that this treatment may be a treatment option for this patient in this particular setting. If at a later point, a different treatment choice is made, the patient remains eligible.

Exclusion Criteria

1. Mental illness/cognitive impairment that limits ability to provide consent or complete trial procedures.
2. Participating to an interventional clinical trial with a non-registered anticancer drug or to another geriatric intervention trial.
3. Patients and caregivers are unable or unwilling to use ICT-devices (tablet, computer, smartphone) or the Internet according to protocol.
4. Patient already included in this study.

Separate list of severe morbidity criteria:

General

1. Two or more unscheduled comorbidity related hospitalisations in the past year (not related to index cancer).
2. Having received out-patient care from two more specialties in the past year (not related to index cancer).

Cardiac
3. Any prior symptomatic myocardial infarction.
4. Any past valve replacement, percutaneous coronary intervention), percutaneous transluminal coronary angioplasty) or coronary artery bypass graft.
5. Congestive heart failure under follow-up by a cardiologist.
6. Chronic exertional angina.
7. Regular use of anti-anginal medication.
8. Left ventricular hypertrophy.
9. Dyspnoea or activity restriction secondary to cardiac status.
10. One or more admissions to hospital for cardiac reasons in past year.

Vascular
11. Previous vascular intervention.
12. Symptomatic atherosclerotic/peripheral vascular disease.

Venous
13. Any history of pulmonary embolism.
14. Use of coumadin/warfarin, heparin, DOAC or NOAC with indication venous disease.

Hypertension
15. Need of three or more types of blood pressure medication.

Haematopoetic
16. Any chronic hematologic disease.
17. Haemoglobin: \<10 g/dL (6.0 mmol/l) (not related to index cancer).

Endocrine
18. Insulin dependence.
19. Diabetes-related complications (retinopathy, neuropathy, nephropathy, coronary artery disease or peripheral arterial disease).
20. Poorly controlled diabetes mellitus or diabetic coma in the past year.
21. Requires adrenal hormone replacement.

Pulmonary
22. Dyspnoea at rest.
23. Limited activities secondary to pulmonary status.
24. Requires oral steroids for lung disease.
25. One or more admissions to hospital for pulmonary reasons in past year.
26. Two or more hospitalisations for pneumonia in past five years.

Renal
27. eGFR \< 30 ml/min.

Hepatobilary
28. Chronic hepatitis.
29. Cirrhosis.
30. Portal hypertension with moderate symptoms.
31. Compensated liver failure.
32. Clinical or lab evidence of biliary obstruction (not related to index cancer).
33. Acute or chronic pancreatitis or hepatitis in past 5 years.

Stomach/intestine
34. Recent ulcers (\<6 months) or any history of ulcers requiring hospitalisation.
35. Any history of inflammatory bowel disease.
36. Any swallowing disorder or dysphagia.
37. Chronic diarrhoea (not related to index cancer).
38. Bowel impaction in the past year (not related to index cancer).
39. Status post bowel obstruction (not related to index cancer).
40. Ostomy/stoma in situ (not related to index cancer).

Nutrition and weight
41. Weight loss more than 6 kg in past six months.
42. Weight loss more than 3 kg in past 1 month.
43. Significantly decreased food intake.
44. Body mass index \< 19 kg/m2.
45. Body mass index \> 38 kg/m2.

Neurologic
46. Status post cerebrovascular accident (CVA) with at least mild residual dysfunction.
47. Any past central nervous system neurosurgical procedure.
48. Neurodegenerative disease including Parkinson's disease, parkinsonism, multiple sclerosis, myasthenia gravis etc.).
49. Requires daily meds for chronic headaches or headaches that regularly interfere with daily activities.

Sensory
50. Partially or functionally blind, unable to read newsprint.
51. Functional deafness or conversational hearing impaired despite hearing aid.
52. Laryngectomy.

Mobility
53. Requires a walking aid/wheelchair.
54. Difficulties in activities of daily living secondary to mobility impairment.
55. Difficulty walking \>100m without resting.
56. Requires steroids or immunosuppressant medication for arthritic condition or connective tissue disease.
57. Prior or current symptomatic vertebral compression fractures from osteoporosis.

Psychiatric
58. Active substance abuse with social, behavioural or medical complications.
59. History of schizophrenia or another psychotic disorder.
60. Requires daily antipsychotic medication.
61. Current usage of daily anti-anxiety medication.
62. Currently meets DSM criteria for major depression or bipolar disorder.
63. One or more episodes of major depression in the past 10 years.
64. Any previous psychiatric hospitalisation.

Cognition/Delirium
65. One or more prior deliriums in the past 10 years.
66. Cognitive impairment that does not inhibit patient to provide informed consent and understand study procedures.

Previous cancer
67. Another type of cancer than the index cancer with at least one of the following criteria:

* Required chemotherapy or radiation therapy in the past 5 years,
* Non-curable and/or metastatic cancer.

Instrumental Activities of Daily Living (IADL)
68. Care dependent in one or more aspects of the following instrumental activities of daily living (preparing meals, walking outside alone, managing medication).

Social
69. Patients has no or very limited support system or informal caregivers.
Minimum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Bordeaux

OTHER

Sponsor Role collaborator

Diakonessenhuis, Utrecht

OTHER

Sponsor Role collaborator

University of Milan

OTHER

Sponsor Role collaborator

University College Dublin

OTHER

Sponsor Role collaborator

Oslo University Hospital

OTHER

Sponsor Role collaborator

International Society of Geriatric Oncology

OTHER

Sponsor Role collaborator

Dublin City University

OTHER

Sponsor Role collaborator

Universitair Ziekenhuis Brussel

OTHER

Sponsor Role collaborator

General Hospital Groeninge

OTHER

Sponsor Role collaborator

AZ Sint-Jan AV

OTHER

Sponsor Role collaborator

Catharina Ziekenhuis Eindhoven

OTHER

Sponsor Role collaborator

Reinier de Graaf Groep

OTHER

Sponsor Role collaborator

KU Leuven

OTHER

Sponsor Role collaborator

Universitaire Ziekenhuizen KU Leuven

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hans Wildiers, prof. dr.

Role: PRINCIPAL_INVESTIGATOR

Coordinator multidisciplinary breast centre (MBC)

Locations

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UZ Gasthuisberg Leuven

Leuven, , Belgium

Site Status

Countries

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Belgium

References

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Hamaker ME, Wildiers H, Ardito V, Arsandaux J, Barthod-Malat A, Davies P, Degol L, Ferrara L, Fourrier C, Kenis C, Kret M, Lalet C, Pelissier SM, O'Hanlon S, Rostoft S, Seghers N, Saillour-Glenisson F, Staines A, Schwimmer C, Thevenet V, Wallet C, Soubeyran P. Study protocol for two stepped-wedge interventional trials evaluating the effects of holistic information technology-based patient-oriented management in older multimorbid patients with cancer: The GERONTE trials. J Geriatr Oncol. 2024 May;15(4):101761. doi: 10.1016/j.jgo.2024.101761. Epub 2024 Apr 5.

Reference Type DERIVED
PMID: 38581958 (View on PubMed)

Other Identifiers

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s66300

Identifier Type: -

Identifier Source: org_study_id

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