Background
First author | Study design | N | Population | Mean age | Intervention | Primary end-point | Results |
---|---|---|---|---|---|---|---|
Bourdel-Marchasson [13] | Multicenter RCT* | 336 | Patients with solid tumor treated by chemotherapy at risk of malnutrition (17 ≤ MNA ≤ 23.5). | 78.0y | 3–6 months diet counselling intervention | 1-year mortality | - Early dietary counselling was efficient in increasing intake but had no beneficial effect on mortality. |
Hempenius [10] | Multicenter RCT | 260 | Frail elderly patients undergoing elective surgery for a solid tumor | ≈77.5y | Geriatric liaison intervention | Postoperative delirium | - Intervention for frail elderly cancer patients receiving surgery to prevent post-operative delirium was not effective. |
Demark-Wahnefried [34] | Multicenter international RCT (RENEW study) | 641 | Overweight long-term survivors (≥5 years) of colorectal, breast and prostate cancer | ≈73y | 12-month diet and exercise intervention via telephone counseling and print materials | Change in functional status (baseline/12-month and 24-month) Diet quality, BMI and physical activity | - Significant change in functional status between intervention group and control group (p < 0.01): amelioration of functional decline in intervention group. Significant change in diet quality, physical activity and BMI (p < 0.01). |
Morey [7] | Change in functional status (baseline/12 m) using the Medical Outcomes Study SF36 questionnaire, health-related QoL | - Significant change in physical function (p = 0.03) and QoL (p = 0.007) between groups. | |||||
Lapid [35] | Subset geriatric analysis from stratified, two-group RCT | 33 | New advanced cancer diagnosis (5-year OS: 0–50 %) planned to receive radiotherapy | ≈72y | 4-week multidisciplinary QoL intervention | QoL measured with Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27 | - Significant improvement in QoL (p < 0.05) at baseline, maintained at 4 and 8 weeks. |
Rao [14] | Subset analysis from RCT [36] | 99 | Frail elderly cancer patients hospitalized on a medical or surgical ward (≥2 days) | ≈74y | Geriatric assessment and patient management by a geriatric attending physician and a social worker | 12-month survival and health-related QoL (after randomization), ADL, physical performance, health service utilization, and costs | - No significant effect on survival or QoL parameters. Positive effects of geriatric inpatient care on mental health and bodily pain (p < 0.05). Days of hospitalization and cost similar. |
Goodwin [6] | Multicenter RCT | 335 | Older women (≥65y) newly (<2 months) diagnosed with breast cancer | ≈72y | 12-month nurse case management | Type and use of cancer-specific therapies received in the first 6 months after diagnosis. Patient satisfaction and arm function | - More appropriate management for women receiving nurse case management (Breast-conserving surgery, adjuvant radiation, radiation therapy, axillary dissection and breast reconstruction surgery). Better arm function and higher satisfaction in intervention group. |
McCorkle [15] | Single centerRCT | 375 | Old patients (≥60y) newly diagnosed with solid cancer | 60–92 | 4-week home-based case management by nurse | Length of survival | - Longer survival in intervention group than in usual care group (p = 0.001). Survival advantage for intervention group in late stage patients. |
Galvao [8] | Two-arm single center RCT | 57 | Prostate cancer patient without bone metastases treated by AST (≥2 months) | ≈70y | 12-week progressive resistance and aerobic training (2/week) by an exercise physiologist | Muscle mass, strength, physical function, QoL | - Significant change in total body lean mass, muscle strength and endurance (p < 0.05). Change in QoL for general health (p = 0.022), vitality (p = 0.019) and physical health composite score (p = 0.02). |
Methods/Design
Objectives
Primary objective
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“Usual care”: Patients are treated according to ongoing standards in oncology.
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“Case-management intervention”: Patients are treated according to ongoing standards in oncology as in the “Usual care” arm. In addition, patients receive geriatric assessments and interventions coordinated by a geriatrician and a trained nurse, and tailored for the patient.
Secondary objectives
Overall study design
Eligibility criteria
Description of the interventions
Development of the standard cancer care and geriatric intervention plans
Description of the intervention for the arm ‘Usual care’
Description of the intervention for the arm “Case-management intervention”
Area | Indication | Intervention |
---|---|---|
Modification of therapy | Polypharmacy | • Re-evaluate treatment indications (with general practitioner), optimize treatment according to elderly patient protocols. |
Balancing chronic diseases | CIRS-G* Grade ≥ 3, | • Adaptation of therapy. |
arterial hypertension, diabetes, arthritis, or sensory problems | • Other non-drug interventions such as dietary advice, devices. | |
• Referral to specialist doctor. | ||
Pain treatment | Pain >1 on numeric scale | • Drug: WHO levels 1–3 antalgic treatment |
• Non-drug: physiotherapy, devices | ||
Nutritional intervention | Malnutrition (MNA* ≤ 17) | • Referral to dietician (nutritional supplements, artificial nutrition, etc.) |
Weight loss ≥5 % over 3 m, or ≥10 % over 6 m | ||
At risk of malnutrition - 17 < MNA ≤ 23.5 | • Advice on increasing dietary uptake (use of food pyramid adapted for elderly patients) | |
Physical activity | Sedentary or at risk of falls | • Recommend daily walk, walking upstairs, carrying groceries |
Physiotherapy | Difficulty with walking and balance (TUG*, and SPPB*). Fall in the last 12 m, weight loss, muscle loss | • Prescribe physiotherapy for muscular reinforcement Work on balance, and getting up from lying down position |
• Prescribe walking aids | ||
Psychological support | GDS* ≥ 6 | • Consultation with psychologist or psychiatrist |
Apparent anxiety (clinical assessment) | ||
Antecedent of depression | ||
Prevention of further cognitive impairment | MMSE* < 24 | • Behavioral monitoring during chemotherapy |
• Prevention of confusion [39] | ||
Treatment for sleeping disorders | Positive screening score on adapted Epworth scale [40] | |
Assistance | Social fragility identified (absence of social support) | • Ask patient directly if help is needed |
• Refer to a social worker | ||
Home help | Difficulties performing daily tasks such as grooming, housework | • Prescribe support within the home (nursing, physiotherapy, housecleaner, etc.) |