title: The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
abstract: BACKGROUND
  Although comorbidities are identified in routine oncology practice, intervention plans for the coexisting needs of older people receiving chemotherapy are rarely made. This study evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer.
  
  
  METHODS
  Comparative study of two cohorts of older patients (aged 70+ years) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010-July 2012) received standard oncology care. The intervention group (N=65, September 2011-February 2013) underwent risk stratification using a patient-completed screening questionnaire and high-risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions.
  
  
  RESULTS
  Intervention participants undergoing CGA received mean of 6.2±2.6 (range 0-15) CGA intervention plans each. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI: 1.50-11.42), P=0.006) and fewer required treatment modifications (OR 0.34 (95% CI: 0.16-0.73), P=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group and 52.9% in the control (P=0.292).
  
  
  CONCLUSIONS
  Geriatrician-led CGA interventions were associated with improved chemotherapy tolerance. Standard oncology care should shift towards modifying coexisting conditions to optimise chemotherapy outcomes for older people.
authors: 1] Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.
authors: T
authors: T
authors: Kalsi
authors: Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
authors: G
authors: G
authors: Babic-Illman
authors: Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors: P J
authors: PJ
authors: Ross
authors: Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors: N R
authors: NR
authors: Maisey
authors: Department of Clinical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors: S
authors: S
authors: Hughes
authors: Department of Haematology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors: P
authors: P
authors: Fields
authors: 1] Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.
authors: F C
authors: FC
authors: Martin
authors: Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.
authors: Y
authors: Y
authors: Wang
authors: 1] Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.
authors: D
authors: D
authors: Harari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016022:Case-Control Studies; D015897:Comorbidity; D004361:Drug Tolerance; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000188:drug therapy* / Q000534:rehabilitation*; D010347:Patient Care Planning; D011379:Prognosis; D011446:Prospective Studies