Nurse navigators may play a key role in mitigating toxicities from chemotherapy and perform geriatric assessments for patients treated at hematology/oncology clinics.
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:
The CARG tool is used to predict cardiac toxicity based on a range of factors including the following3:
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