Practical delivery of geriatric assessment in community oncology settings

Older adults will constitute 75% of the projected 22.2 million US cancer survivors by 2030, with the largest growth among older survivors (age 65 and up). This older population is at higher risk of adverse events due to cancer treatment, but these adverse outcomes can be mitigated by personalized treatment plans accounting for domains of aging. Our long-term goal is to increase delivery of practical geriatric assessment in community oncology settings to improve patient outcomes in clinics with limited specialized resources. Geriatric assessment was recommended by the National Comprehensive Cancer Network and the American Society of Clinical Oncology (ASCO) for adults age 65 and older who are candidates for systemic therapy, with updated guidelines released in 2023.

While geriatric assessment is an evidence-based approach to improve patient outcomes and is recommended by these key professional societies, it is not widely used in practice. We will compare ASCO educational materials for practical geriatric assessment (control) to six months of the same information delivery supplemented with implementation support, followed by twelve months of maintenance support (intervention). To this end, we will first pilot our implementation supports in three practices and will refine our protocol (UG3) to prepare for our UH3-Phase parallel practice randomized trial including 20 practices in the NCI Community Oncology Research Program (NCORP). The control materials will include ASCO educational materials for providers including the guidelines, “how to” videos, and an action table for how to operationalize screening results.

Implementation supports will include promoting adaptability, facilitation (workflow tailoring), and education and training, to overcome identified implementation barriers. In Aim 1, we will measure reach (% patients receiving practical geriatric assessment; primary outcome), adoption (% providers delivering practical geriatric assessment), implementation (documentation of GA-guided management), among n=960 patient chart reviews. In Aim 2 we will survey patients to assess effectiveness (provider communication, toxicity, and quality of life). In Aim 3, to assess sustainability, we will conduct a chart review among a distinct sample of n=960 to assess maintenance (practical geriatric assessment >6 months after completion of implementation supports; secondary), adaptations to the PGA delivery, and contextual factors affecting delivery of practical geriatric assessment.

Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we will use surveys, interviews, and site observations to document contextual factors that influence intervention delivery, with attention to differences in delivery based on consideration of patient and organizational characteristics such as insurance coverage, geographic location, clinic staffing and volume, and proximity to referral offices.

Grant Number: 1UG3CA293878-01A1
NIH Institute/Center: NIH
Principal Investigator: Hannah Arem