Effectiveness of comprehensive geriatric assessment with patient coaching on toxicity, premature treatment interruption, unplanned hospitalisations, and survival in older patients with solid tumours: Secondary endpoints of the G-oncoCOACH study.

INTRODUCTION

The Belgian G-oncoCOACH study previously showed improved quality of life (QoL) with Comprehensive Geriatric Assessment (CGA) combined with patient coaching for older patients with cancer receiving systemic therapy. This secondary data analysis evaluated the effectiveness of CGA with patient coaching on grade 3/4 toxicity, premature interruption of systemic therapy, unplanned hospitalisations (UH), and overall survival (OS).

MATERIALS AND

METHODS

This multicentre RCT included patients aged ≥70 years with solid tumours, life expectancy >6 months, who were starting systemic therapy (curative or palliative intent). Patients were randomized to either a Control Group (CG) receiving standard care with CGA-based recommendations by the geriatric team to the oncology team or an Intervention Group (IG) receiving CGA with intensive patient coaching, implemented by the geriatric team. Comparative analyses for grade 3/4 toxicity, premature interruption of systemic therapy, and UH were performed using the Chi-square test. OS was analysed using Kaplan-Meier analysis and compared with the Log-rank test.

RESULTS

Between October 2019 and September 2021, 212 patients were enrolled: 107 in the CG and 105 in the IG. There was no significant difference between the CG and IG for grade 3/4 toxicity (48/107 [44.9%] versus 42/105 [40.0%]; p = 0.47), for premature interruption of systemic therapy (43/107 [40.2%] versus 39/105 [37.1%]; p = 0.56) or for UH (57/107 [53.3%] versus 48/105 [45.7%]; p = 0.27). Median OS was 23.5 months in the CG (95%CI 15.4;31.6) and 18.8 months in the IG group (95%CI 11.2;26.4) (p = 0.47). Subgroup analysis showed no significant differences except among patients with an abnormal G8 receiving chemotherapy as part of their systemic therapy, where grade 3/4 toxicity was significantly lower in the IG (p = 0.03) and there was a trend toward less premature interruption of systemic therapy in the IG (p = 0.06), which became statistically significant when excluding disease progression as a cause for premature interruption (p = 0.03).

DISCUSSION: Although no significant differences were observed overall, our results suggest that CGA with patient coaching may reduce toxicity and premature interruption of systemic therapy in frail patients receiving chemotherapy, a subgroup at highest risk for poor outcomes.