Evaluating the association of frailty with communication about aging‐related concerns between older patients with advanced cancer and their oncologists
Authors: Gilmore Nikesha , Xu Huiwen , Kehoe Lee , Kleckner Amber S. , Moorthi Kiran , Lei Lianlian , Mohamed Mostafa R. S. , Loh Kah Poh , Culakova Eva , Flannery Marie , Ramsdale Erika , Duberstein Paul R. , Canin Beverly , Kamen Charles , Giri Gilbert , Watson Erin , Patil Amita , Onitilo Adedayo A. , Burnette Brian , Janelsins Michelle , Mohile Supriya G. 
Published: November 2021

Background

A geriatric assessment (GA) intervention improves communication about aging‐related concerns, but its effect on communication in patients with various levels of frailty is unknown.

Methods

This was a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and impairment on 1 or more GA domains (ClinicalTrials.gov Identifier NCT02107443; principal investigator Supriya G. Mohile). Practice sites were randomized to either the GA‐intervention or usual care. Frailty was assessed with a deficit accumulation index (range, 0‐1), and patients were stratified as robust (0 to <0.2), prefrail (0.2 to <0.35), or frail (≥0.35). The clinic visit after the GA‐intervention was audio‐recorded, transcribed, and coded to evaluate the number and quality of conversations about aging‐related concerns. Linear mixed models examined differences in the number and quality of conversations within and between arms. All P values were 2‐sided.

Results

Patients (n = 541) were classified as robust (27%), prefrail (42%), or frail (31%). In the usual care arm, frail patients (vs robust ones) engaged in more aging‐related conversations (adjusted mean difference, 1.73; 95% confidence interval [CI], 0.59‐2.87), conversations of higher quality (difference, 1.12; 95% CI, 0.24‐2.0), and more discussions about evidence‐based recommendations (difference, 0.71; 95% CI, 0.04‐1.38; all P values ≤ .01). Similarly, in the GA intervention arm, frail patients (vs robust ones) engaged in more aging‐related conversations (difference, 2.49; 95% CI, 1.51‐3.47), conversations of higher quality (difference, 1.31; 95% CI, 0.56‐2.06), and more discussions about evidence‐based recommendations (difference, 0.87; 95% CI, 0.32‐1.42; all P values ≤ .01). Furthermore, the GA‐intervention significantly improved the number and quality of conversations in all patients: robust, prefrail, and frail (all P values ≤ .01).

Conclusions

Patients with higher degrees of frailty and those exposed to the GA‐intervention had more and higher quality conversations about aging‐related concerns with oncologists.

Lay Summary

A geriatric assessment (GA) intervention improves communication about aging‐related concerns, but its effect on communication in patients with various levels of frailty is unknown.

This study conducted a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and 1 or more GA domain impairments. Patients were stratified as robust, prefrail, or frail.

The number and quality of conversations about aging‐related concerns that occurred during the clinic visit after the GA‐intervention were determined.

Patients with higher degrees of frailty and those in the GA intervention arm had more and higher quality conversations about aging‐related concerns with oncologists.