Older Patients With Cancer Get Help Coping With Uncertainty

TOPLINE:

A geriatric assessment-guided intervention with supportive care (GAIN-S) enhanced emotional and adaptive domains of prognostic awareness in older adults with metastatic cancer, with mean differences of 1.14 and 0.82, respectively, compared with usual care. The telehealth-based intervention improved coping with prognostic uncertainty and emotional acceptance among 77 participants aged 65 years or older.

METHODOLOGY:

• Previous studies demonstrate geriatric assessment’s benefits in improving treatment tolerance, advance directive completion, quality of life, and communication. While geriatric assessment provides valuable prognostic information to clinicians, its impact on patients’ prognostic awareness remains underexplored, particularly in older adults who may overestimate their prognosis.
• Researchers conducted a randomized controlled trial in Brazil between June 2022 and July 2023, enrolling adults aged 65 years or older with metastatic cancer who were receiving systemic cancer treatment.
• Participants (N = 77; mean age, 74.5 years; 56% women) were randomized 1:1 to receive either GAIN-S intervention (n = 39) or usual care (n = 38), with common cancers including genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%).
• Analysis utilized the Prognostic Awareness Impact Questionnaire covering emotional (10 items; range, 0-30), adaptive (12 items; range, 0-36), and cognitive domains (two categorical items).
• Intervention group received multidisciplinary geriatric assessment review, individualized care planning, and targeted referrals delivered using telehealth, while usual care consisted of standard treatment without geriatric assessment-guided interventions.

TAKEAWAY:

• GAIN-S intervention led to greater improvements (mean difference, 1.14; standard error [SE], 0.35; P = .002) in emotional domain and (mean difference, 0.82; SE, 0.30; P = .008) in adaptive domain compared with usual care.
• Participants in the GAIN-S group demonstrated improved coping with prognostic uncertainty (mean rank, 43.28 vs 34.61; P = .005) and better emotional acceptance of unclear prognoses (mean rank, 43.77 vs 34.11; P = .001).
• GAIN-S participants reported reduced stress when discussing prognosis with their oncology team (mean rank, 45.7 vs 32.2; P = .002) and improved emotional acceptance of prognosis (mean rank, 42.4 vs 35.6; P = .0079).
• Most participants indicated their oncologist had not clearly communicated cancer curability (74% GAIN-S vs 57% usual care), while no significant differences were observed in the cognitive domain.

IN PRACTICE:

“By fostering a more accurate understanding of prognosis alongside improved psychological resilience, GA [geriatric assessment] may help older adults with metastatic cancer engage in better informed, values-based decision-making regarding their care expectations. Importantly, these benefits were achieved through telehealth,” the authors of the study wrote.

SOURCE:

This study was led by Cristiane Decat Bergerot, PhD, Oncoclinicas & Co, Medica Scientia Innovation Research in Sao Paulo, Brazil. It was published online in Cancer.

LIMITATIONS:

According to the authors, while the GAIN-S intervention was associated with improved coping and psychological adaptation, they could not determine whether these changes influenced patients’ ultimate treatment decisions. This study was conducted in a single healthcare network in a developing country, potentially limiting generalizability to other settings. Due to the modest sample size limiting power, findings should be considered preliminary and require validation in larger studies.

DISCLOSURES:

This study received support from National Institute on Aging grants NIA 2K24 AG055693 and NIA 2R33 AG059206. Bergerot reported no relevant conflicts of interest. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.