We did other work earlier about systematic reviews and then there was no trial of geriatric assessment and management. So before we could plan a larger trial we needed to do this feasibility trial to get some more information that we needed to plan a larger trial. We needed to know if it was feasible, what will be the best way of delivering the intervention, were older adults interested in participating such the trial would our data collection points because they are also receiving chemotherapy treatment. So we needed to make sure we captured our necessary data to have any idea about the effectiveness as well as the burden on the patient for being in this study. So for all these different reasons we did this feasibility trial.
Has geriatric assessment changed in recent years?
There has always been a focus in geriatric oncology on implementing geriatric assessment and finding the best way to identify those people that could benefit the most from geriatric assessment. In our trial we just decided to go based on the age so everybody aged 70 years and over who were starting the first time chemotherapy treatment was eligible because we didn’t have a better way in our centre for identifying who were the more frail patients because that’s the population we think can benefit the most from geriatric assessment but we didn’t have a systematic way of identifying those so we just went based on age. But in more recent years there’s now more of a push intervention because an assessment is just an assessment, it’s not going to change anything. So we really need to come up with a care plan that’s tailored to the patient that addresses their priorities and takes into account their preferences and then delivers that concurrently with cancer treatment or prior if the issues are better addressed before so that they go in in the best condition for their treatment.
What is needed in the future for geriatric assessment?
We need more interventions. Like we did our feasibility trial and the group completed a similar feasibility trial so now we need a larger trial to really show that it is effective in improving clinical outcomes in order for a lot of countries for this to be implemented. Included we need cost effectiveness data that we can actually show the benefit for that as well that geriatric assessment, of course, when you identify the issues up front and address them and somewhere down the line it should save you money from not having unnecessary emergency room visits or hospitalisation or something like that, that you hope to have them better during the treatment that you prevent more unplanned healthcare use. So we need those larger studies.
Are there any key messages from the trials?
Our feasibility trial and we know from the observational studies too that it’s feasible to do these interventions, patients are willing to participate in that but in order to get into routine clinical care we need to show really the benefits because it’s a cost intensive intervention, a lot of cancer centres don’t have access to a dietician, social worker and all these other things that you need for care for older people. So having this evidence could convince hospital administrators or those who are financially responsible to make these services more widely available for older adults.