Using an electronic capture geriatric assessment to guide rehabilitation triage for adults with cancer during systemic therapy.
Authors: Kendig Tiffany , Wood Kelley C , Bertram Jessica , Hidde Mary , Ronnen Ellen A. , Lightner Ashley N , Mayo Stacye , Hedaya Alina , Newell Alaina M. , Meehan Deanna , Hutzayluk Katie , Carroll Rachel , Williams Grant Richard , Pergolotti Mackenzi 
Published: October 2023

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Background: Frailty is associated with poor treatment and survival outcomes but is modifiable if identified and intervened upon early on. ASCO recommends using a geriatric assessment (GA) to identify frailty and guide referrals to interventions to optimize patient outcomes, including rehabilitation (physical and occupational therapy (PT/OT). Yet, using a GA to guide PT/OT referrals is rare, especially in community-based oncology settings. To address this gap, we conducted a pilot feasibility study of a GA-based electronic frailty monitoring and PT/OT triage system. Methods: Adults with cancer starting a new line of systemic therapy at a community-based oncology private practice enrolled in the study. Participants completed a monthly online GA for up to one year. Frailty was identified in real-time from GA responses using a validated 44-item deficit accumulation method [frail (>0.35), pre-frail (>0.2-0.35), or robust (0-0.2)]. Clinicians were notified to place a referral for PT/OT when patients were identified as frail or pre-frail. We evaluated feasibility via participant enrollment and retention rate, oncology compliance to referral triggers, participant conversion to PT/OT, and a 5-item participant experience (PE) survey. For participants who attended rehabilitation, we evaluated changes in health-related quality of life using PROMIS outcomes collected during rehabilitation. PROMIS outcomes included global physical (GPH) and mental (GMH) health, physical function (PF), and the ability to participate in social roles and activities (SRA). Results: Of 537 eligible patients, 26% enrolled (N=141). Participants completed a median of 3 GA (IQR: 1-10). Frailty was identified on 40% of all GA, resulting in 282 referrals to PT/OT (99% compliance) and 110 PT/OT evaluations (40% conversion). Participants attended a median of 6 PT/OT visits (IQR: 2 to 19) and 47% had outcomes available at initial evaluation and discharge (n=52). Significant improvements were observed in GPH (Mean∆=2.82±6.96, p=.003), GMH (Mean∆=3.71±7.76, p<.001), PF (n=48, Mean∆=2.31±7.18, p=.015) and non-significant improvements were observed in SRA (n=48, Mean∆=1.53±6.90, p=.066). Most who completed the PE survey (N=44) agreed the GA was simple to complete (98% agreement), took an appropriate amount of time (93% agreement, median: 10 min), was helpful to monitor for treatment side effects (77% agreement), was an added benefit to their care (72% agreement), and they would recommend to peers (79% agreement). Conclusions: An electronic capture frailty monitoring and PT/OT triage system using patient-reported GA was feasible in a community oncology practice and positively impacted patients’ health-related quality of life and experience during systemic therapy. Community oncology practices using GA should incorporate PT/OT triage into routine care to optimize patient outcomes and experience. Clinical trial information: NCT04852575 .