Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis

被引：24
作者：
Anwar, Mohammed Rashidul [1 ]
Yeretzian, Shant Torkom [2 ]
Ayala, Ana Patricia [3 ]
Matosyan, Emma [4 ]
Breunis, Henriette [5 ]
Bote, Kathyrin [6 ]
Puts, Martine [6 ]
Habib, Mohammed Hassan [7 ]
Li, Qixuan [8 ]
Sahakyan, Yeva [9 ]
Alibhai, Shabbir M. H. [1 ,7 ,10 ]
Abrahamyan, Lusine [1 ,9 ,11 ,12 ]
机构：
[1] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[2] Amer Univ Armenia, Turpanjian Coll Hlth Sci, Yerevan, Armenia
[3] Univ Toronto, Gerstein Sci Informat Ctr, Toronto, ON, Canada
[4] Univ Western Ontario, London, ON, Canada
[5] Univ Hlth Network, Dept Support Care, Toronto, ON, Canada
[6] Univ Toronto, Lawrence S Bloomberg Fac Nursing, Toronto, ON, Canada
[7] Univ Hlth Network, Dept Med, Toronto, ON, Canada
[8] Univ Hlth Network, Biostat Res Unit, Toronto, ON, Canada
[9] Univ Hlth Network, Toronto Hlth Econ & Technol Assessment THETA Colla, Toronto, ON, Canada
[10] Univ Toronto, Dept Med, Toronto, ON, Canada
[11] Univ Hlth Network, Toronto Gen Hosp Res Inst, Toronto, ON, Canada
[12] Toronto Gen Hosp Res Inst, Dept Med, 10th Floor Eaton North, Room 237, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
来源：
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE | 2023年 / 115卷 / 12期
关键词：
ADULTS; ONCOLOGY; TRIAL; INTERVENTIONS; CONSENSUS; SURVIVAL; QUALITY; SOCIETY; IMPACT;
D O I：
10.1093/jnci/djad200
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
Background Frailty and multimorbidity among older cancer patients affect treatment tolerance and efficacy. Comprehensive geriatric assessment and management is recommended to optimize cancer treatment, but its effect on various outcomes remains uncertain.Objective Our objective was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) and cost-effectiveness studies comparing comprehensive geriatric assessment (with or without implementation of recommendations) to usual care in older cancer patients.Methods We searched MEDLINE, EMBASE, CINAHL, and Cochrane trials from inception to January 27, 2023, for RCTs and cost-effectiveness studies. Pooled estimates for outcomes were calculated using random-effects models.Results A total of 19 full-text articles representing 17 RCTs were included. Average participant age was 72-80 years, and 31%-62% were female. Comprehensive geriatric assessment type, mode of delivery, and evaluated outcomes varied across studies. Meta-analysis revealed no difference in risk of mortality (risk ratio [RR] = 1.08. 95% confidence interval [CI] = 0.91 to 1.29), hospitalization (RR = 0.92, 95% CI = 0.77 to 1.10), early treatment discontinuation (RR = 0.89, 95% CI = 0.67 to 1.19), initial dose reduction (RR = 0.99, 95% CI = 0.99 to 1.26), and subsequent dose reduction (RR = 0.87, 95% CI = 0.70 to 1.09). However, the risk of treatment toxicity was statistically significantly lower in the comprehensive geriatric assessment group (RR = 0.78, 95% CI = 0.70 to 0.86). No cost-effectiveness studies were identified.Conclusion Compared with usual care, comprehensive geriatric assessment was not associated with a difference in risk of mortality, hospitalization, treatment discontinuation, and dose reduction but was associated with a lower risk of treatment toxicity indicating its potential to optimize cancer treatment in this population. Further research is needed to evaluate cost-effectiveness.
引用
收藏
页码：1483 / 1496
页数：14
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