Practical Geriatric Assessment (PGA) Implementation Strategies and Correlative Evaluations for Older Adults With Cancer (PACE-70): A Hybrid Implementation-effectiveness Study
Abramson Cancer Center at Penn Medicine
Summary
The use of a geriatric assessment to inform oncologic care for older persons with cancer is an evidence-based practice that improves patient-clinician communication, reduces treatment-related toxicity, and is recommended by national guidelines. However, the implementation of a geriatric assessment can be time-consuming and burdensome, leading to suboptimal use in clinical practice. Developed and endorsed by the American Society for Clinical Oncology (ASCO), the Practical Geriatric Assessment (PGA) is designed to improve clinical usability and adoption, but its implementation in real-world settings has not been evaluated. The PACE-70 study aims to evaluate PGA implementation and resultant chemotherapy dose modification among older adults with advanced cancer treated in a community setting. An exploratory aim will evaluate how the PGA, body composition (via abdominal computed tomography scan) and step count monitoring (via FitBit) correlate with chemotherapy toxicity and other clinical outcomes.
Description
Advancing age is the most significant risk factor for cancer. By 2040, it is projected that 60 percent of newly diagnosed cancer cases will occur in individuals aged 70 years or older.5 Managing cancer in older adults requires careful evaluation of treatment risks and benefits, as over 70 percent of older patients experience grade 3+ adverse events, which can impact quality of life and necessitate therapy modifications.6 Moreover, adults over 75 years represent less than 2 percent of participants in phase 3 oncology trials despite constituting 20 percent of incident cancer diagnoses. Consequen…
Eligibility
- Age range
- 70+ years
- Sex
- All
- Healthy volunteers
- No
For PGA Implementation Cohort, patients must meet the following criteria: 1. Age greater than or equal to 70 years. 2. Diagnosis of advanced or metastatic solid malignancy 3. Initiating a new line of palliative-intent systemic therapy with a prevalence of grade 3 toxicity exceeding 50%. For Correlative Analysis Cohort, patients must additionally meet the following criteria: 1. Must read and speak English and be able to fill out surveys 2. Ability to walk independently or with the use of an assistive device (e.g., walker, cane) 3. Consents to participate in correlative analysis cohort with F…
Interventions
- OtherPractical Geriatric Assessment
The PGA will be administered via the electronic health record (EHR), available for patients to complete independently prior to an initial medical oncology visit, or during the visit with staff assistance. Results from the PGA will be shared automatically with clinical teams via the EHR, including a Best Practice Alert highlighting any identified geriatric impairment(s) and ASCO's recommendation for PGA-adapted care.
- OtherCorrelation of body composition PGA and step count with outcomes
Monitoring of step counts (measured via FitBit) and body composition (measured via standard abdominal CT scans)
Locations (3)
- Penn Medicine Princeton Medical CenterPrinceton, New Jersey
- Lancaster General HospitalLancaster, Pennsylvania
- Pennsylvania HospitalPhiladelphia, Pennsylvania