Geriatric Assessment Rates Improve With Nurse Navigator Intervention

Nurse navigators may play a key role in mitigating toxicities from chemotherapy and perform geriatric assessments for patients treated at hematology/oncology clinics, according to data from a pilot project presented at the 2022 ASCO Annual Meeting.¹

Investigators assessed the use of the G8 questionnaire to identify vulnerable geriatric patients with cancer and the Cancer and Aging Research Group (CARG) scoring tool to calculate chemotherapy toxicity risk among patients aged 65 years or older. These tools are used to stratify those at-risk for severe adverse effects using information beyond age as a guide for treatment decisions and improve outcomes. The tools also aid in the referral of patients with vulnerabilities to external services for follow-up treatment.

Completion rate of these assessments is between 20% and 35% when administered by physicians and investigators sought to improve completion rates with assistance of nurse navigators.

Seven community cancer centers were included in the pilot program and the study period lasted from May 1, 2021, to December 31, 2021, G8 assessment was administered at all 7 sites and CARG plus G8 assessments were administered among patients with solid tumors receiving chemotherapy at 4 of the 7 sites.

In total, 1372 patients were eligible to undergo G8 assessment and 563 were eligible for CARG assessment. The completion rates of the assessments were 78.9% and 91.6%, respectively, when administered by a nurse navigator.

“Nurse navigators can successfully implement G8 and CARG toxicity tool in hematology-oncology clinics in a broad range of cancer types at a high rate with resultant referrals to multiple supportive services in real-world settings,” the study authors wrote in a poster of the data.¹

Referrals to external services were also initiated among the population and included 193 referrals for nutrition services, 30 for audiology, 18 for physical therapy, 5 for psychiatry, and 5 for neurology. The median age of patients in the eligible population was 74 years (range, 65-100) with a near even split between men (48%) and women (52%). Patients has a range of cancers including genitourinary (18%), breast (17%), upper gastrointestinal (15%), and thoracic cancers (13%).

The G8 assessment produces a score ranging from 0 to 17 based on fitness characteristics of patients.² The questions include the following:

• Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?
• Weight loss during the past 3 months
• Mobility (ie, able to get out of bed/chair)
• Neuropsychological problems (ie, severe dementia or depression)
• Body mass index
• Takes more than 3 medications per day
• Heath assessed in comparison with other individuals the patient’s age
• Age

The CARG tool is used to predict cardiac toxicity based on a range of factors including the following³:

1. Age
2. Primary tumor site (ie, genitourinary or gastrointestinal cancer)
3. Standard chemotherapy dose
4. Number of chemotherapy drugs
5. Laboratory results (ie, hemoglobin and creatinine clearance)
6. Falls
7. Hearing impairment
8. Fitness (ie, ability to walk 1 block)
9. Ability to self-administer medication
10. Socialization (ie, observed decreases because of physical and emotional health)

ASCO guidelines for geriatric oncology recommend that patients aged 65 years and older should undergo assessment to identify risks that not routinely captured in clinical assessments. The recommendations include both the G8 and CARG tools as supplemental assessments for geriatric assessment in the clinic.⁴

Reference

1. Shaia JL, Liu R, Sun H, et al. Nurse navigator–initiated geriatric assessments in hematology/oncology clinics. J Clin Oncol. 2022;40(suppl 16):12051. doi:10.1200/JCO.2022.40.16_suppl.12051
2. Bellera CA, Rainfray M, Mathoulin-Pélisser S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2021;23(8): 2166-2172. doi:10.1093/annonc/mdr587
3. Kim J, Hurria A. Determining chemotherapy tolerance in older patients with cancer. J Natl Compr Canc Netw. 2013;11(12):1494-502. doi:10.6004/jnccn.2013.0176
4. Mohile SG, Dale W, Somerfield MR, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol. 2018;36(22):2326-2347. doi