Cancer · 2025
The impact of a geriatric assessment-guided management intervention (GAIN-S) on prognostic awareness: A randomized controlled trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Bergerot Cristiane Decat, Bergerot Paulo Gustavo, Razavi Marianne, Vinicius da Silva França Marcos, Gomes da Silva Jonas Ribeiro, Cerveira Jose Adolfo, Fuzita William Hiromi, Marques Dos Anjos Gabriel, Ferrari Renata, Philip Errol J, Laloni Mariana Tosello, Moreira Ferreira Carlos Gil, Buso Marco Murilo, Pal Sumanta K, Nipp Ryan, El-Jawahri Areej, Soto-Perez-de-Celis Enrique, Dale William
Аннотация
BACKGROUND: Geriatric assessment (GA)-guided supportive care (GAIN-S) may improve decision-making in older adults with cancer, but its effects on prognostic awareness remain unclear. The authors evaluated whether GAIN-S enhances prognostic awareness among older adults with metastatic cancer in Brazil.
METHODS: This randomized controlled trial was conducted in Brazil (June 2022-July 2023). Adults ≥65 years old with metastatic cancer were randomized 1:1 to GAIN-S (n = 39) or usual care (UC; n = 38). GAIN-S included multidisciplinary GA review, individualized care planning, and targeted referrals. UC consisted of standard care without GA-guided interventions. Prognostic awareness was assessed using the Prognostic Awareness Impact Questionnaire, covering emotional (10 items; range, 0-30), adaptive (12 items; range, 0-36), and cognitive (2 categorical items) domains. Group differences were analyzed using t-tests; item-level analyses used Mann-Whitney U, McNemar's, or χ2 tests.
RESULTS: Seventy-seven participants were enrolled (mean age, 74.5; 56% female). Common cancers included genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). GAIN-S led to greater improvements in emotional (mean difference = 1.14, standard error [SE] = 0.35, p = .002) and adaptive (mean difference = 0.82, SE = 0.30, p = .008) domains compared to UC. No differences were observed in the cognitive domain. Most participants reported their oncologist had not clearly stated whether their cancer was curable (74% GAIN-S vs. 57% UC). GAIN-S participants more often reported improved coping with prognostic uncertainty, better emotional acceptance, and reduced distress (all p < .05).
CONCLUSIONS: GAIN-S improved emotional and adaptive domains of prognostic awareness. These novel findings underscore the value of the GAIN-S intervention for older adults. Studies are needed to explore longer-term effects on decision-making, communication, and quality of life.
METHODS: This randomized controlled trial was conducted in Brazil (June 2022-July 2023). Adults ≥65 years old with metastatic cancer were randomized 1:1 to GAIN-S (n = 39) or usual care (UC; n = 38). GAIN-S included multidisciplinary GA review, individualized care planning, and targeted referrals. UC consisted of standard care without GA-guided interventions. Prognostic awareness was assessed using the Prognostic Awareness Impact Questionnaire, covering emotional (10 items; range, 0-30), adaptive (12 items; range, 0-36), and cognitive (2 categorical items) domains. Group differences were analyzed using t-tests; item-level analyses used Mann-Whitney U, McNemar's, or χ2 tests.
RESULTS: Seventy-seven participants were enrolled (mean age, 74.5; 56% female). Common cancers included genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). GAIN-S led to greater improvements in emotional (mean difference = 1.14, standard error [SE] = 0.35, p = .002) and adaptive (mean difference = 0.82, SE = 0.30, p = .008) domains compared to UC. No differences were observed in the cognitive domain. Most participants reported their oncologist had not clearly stated whether their cancer was curable (74% GAIN-S vs. 57% UC). GAIN-S participants more often reported improved coping with prognostic uncertainty, better emotional acceptance, and reduced distress (all p < .05).
CONCLUSIONS: GAIN-S improved emotional and adaptive domains of prognostic awareness. These novel findings underscore the value of the GAIN-S intervention for older adults. Studies are needed to explore longer-term effects on decision-making, communication, and quality of life.