Telehealth-based, geriatric assessment-guided supportive care interventions (GAIN-S) for older adults with advanced cancer: A randomized clinical trial in Brazil.
Authors: Bergerot Cristiane Decat , Bergerot Paulo Gustavo , Silva Jonas Ribeiro Gomes , Cerveira Jose Adolfo , Paes Marcio Almeida , Fuzita William Hiromi , Vasconcellos Vitor Fiorin de , Farias Janice , Matos Neto Joao Nunes , Franca Marcos V S , Patriota Carolina Bezerra , Hada Aline Lury , Anjos Gabriel dos , Taveira Mariane Cunha , Couto Milena Macedo , Buso Murilo , Nipp Ryan David , El-Jawahri Areej , Soto Pérez de Celis Enrique , Dale William 
Published: October 2023

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Background: Older adults with cancer in developing countries often encounter obstacles in accessing specialized medical services. We conducted a randomized clinical trial to investigate the feasibility and preliminary efficacy of integrating telehealth-based multimodal geriatric assessment (GA)-guided supportive care interventions (GAIN) for older adults with advanced cancer in Brazil. Methods: Patients aged 65 and above with metastatic cancer receiving first- or subsequent-line treatment were recruited from Brazilian cancer practices and randomly assigned 1:1 to usual care or GAIN-S. Baseline assessments included telehealth-based measures of physical function (Instrumental Activities of Daily Living), depression symptoms (Geriatric Depression Scale), and quality of life (QOL, Functional Assessment of Cancer Therapy-General). The intervention group received multi-modal interventions entailed reviewing patients' needs based on baseline GA and providing remote consultation with supportive care services such as physical activity (supervised resistance, aerobic, and mobility exercises), nutrition, psychosocial support based on their needs. Usual care patients could be referred to the supportive care team upon request. Follow-up at 3 months included GA for both groups. Feasibility was defined as the proportion of patients who followed the intervention. T-tests were used to compare the means of two groups related to physical function, depression symptoms, and QOL. Results: Among 46 approached patients, 40 were included, with 20 allocated to each arm. Clinical characteristics were balanced between groups. Median age was 71 years (range: 65-88). Generally, patients were female (62%), married (57%), and had at least a college degree (52%). Breast (27%), gastrointestinal (22%), and genitourinary (15%) were the most common diagnoses. In the GAIN-S arm, 80% completed all aspects of the intervention, with few refusals (10%) and reports of worsened symptoms (5%). GAIN-S arm patients were most often referred for physical activity (85%), psychologists (55%), nutritionists (55%), and psychiatrists (20%). Notably, GAIN-S arm patients demonstrated significant improvements compared to control arm patients (Table). Conclusions: These findings highlight the feasibility and promising potential efficacy of integrating GAIN-S for older adults with advanced cancer. The significant improvements in physical function, depression symptoms, and QOL emphasize the importance of tailored supportive services and the potential of remote intervention in overcoming outcomes barriers and improving outcomes for older patients with cancer.[Table: see text]