Research Abstract: Free Paper - Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial (#35)

Wee Kheng Soo 1 2 3 , Madeleine King 4 , Alun Pope 1 , Phillip Parente 1 2 , Pēteris Dārziņš 1 3 , Ian D Davis 1 2
  1. Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
  2. Cancer Services, Eastern Health, Box Hill, VIC, Australia
  3. Aged Medicine Program, Eastern Health, Box Hill, VIC, Australia
  4. School of Psychology, University of Sydney, Sydney, NSW, Australia

Aims To evaluate whether CGA can improve health-related quality of life (HRQOL) in older people with cancer who are starting systemic anticancer treatment.

Methods INTEGERATE is a multicentre, open-label, pragmatic, parallel-group, randomised controlled trial conducted in three Australian hospitals. Participants aged 70 years and older with solid cancer or diffuse large B-cell lymphoma planned for chemotherapy, targeted therapy, or immunotherapy, were randomly assigned (1:1; balancing treatment intent, cancer type, age, sex, and performance status) to receive CGA integrated into oncology care (integrated oncogeriatric care) or usual care only. The primary outcome was HRQOL over 24 weeks, assessed at baseline, week 12, week 18, and week 24, using the Elderly Functional Index (ELFI; score range 0–100).

Results Between Aug 18, 2014, and Sept 5, 2018, 154 participants were randomly assigned to integrated oncogeriatric care (n=76) or usual care (n=78). Participants assigned to integrated oncogeriatric care reported better adjusted ELFI change scores over 24 weeks compared with those in the usual care group (overall main effect of group: t=2·1, df=213, p=0·039; effect size=0·38), with maximal between-group differences at week 18 (mean difference in change 9·8 [95% CI 2·4–17·2]; p=0·010, corrected p=0·030, effect size=0·48). The integrated oncogeriatric care group also had significantly fewer unplanned hospital admissions at 24 weeks (multivariable-adjusted incidence rate ratio 0·60 [95% CI 0·42–0·87]; p=0·0066).

Conclusions CGA led to better quality of life and healthcare delivery in older people receiving systemic anticancer treatment. Routine CGA-based interventions should be considered in at-risk older people starting systemic anticancer treatment.

  1. Soo WK, King MT, Pope A, Parente P, Dārziņš P, Davis ID. Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial. Lancet Healthy Longev. 2022 Sep;3(9):e617-e627. doi: 10.1016/S2666-7568(22)00169-6. Epub 2022 Aug 22. PMID: 36102776.
  2. Soo WK, King M, Pope A, Steer C, Devitt B, Chua S, Parente P, Davis ID, Dārziņš P. The Elderly Functional Index (ELFI), a patient-reported outcome measure of functional status in patients with cancer: a multicentre, prospective validation study. Lancet Healthy Longev. 2021 Jan;2(1):e24-e33. doi: 10.1016/S2666-7568(20)30036-2. Epub 2020 Dec 17. PMID: 36098126.