In this podcast, Dr. William Dale will discuss new research presented at the International Society of Geriatric Oncology 2020 Annual Meeting, held virtually on October 1st. Dr. Dale is director of the Center for Cancer and Aging Research at City of Hope, a comprehensive cancer center near Los Angeles. He is also the Cancer.Net Associate Editor for Geriatric Oncology.
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In this podcast, Dr. William Dale will discuss new research presented at the International Society of Geriatric Oncology 2020 Annual Meeting, held virtually on October 1st.
Dr. Dale is director of the Center for Cancer and Aging Research at City of Hope, a comprehensive cancer center near Los Angeles. He is also the Cancer.Net Associate Editor for Geriatric Oncology. View Dr. Dale’s disclosures at Cancer.Net.
ASCO would like to thank Dr. Dale for discussing this topic.
Dr. Dale: Hello. Welcome to Cancer.Net. Today, I'm going to discuss research highlights presented at the 2020 International Society of Geriatric Oncology, or SIOG, Annual Meeting. I'll be discussing 2 kinds of studies. One, the rapid-fire abstracts, which were the featured abstracts in this year's virtual meeting of SIOG. And at the end, a practice-changing article that was presented. I don't have any disclosures for the rapid-fire abstracts. However, the article that was chosen for hematology to be the most relevant and practice changing this year is 1 in which I participate as a coauthor. But the majority of the work was done by others. And I will describe it when we get to that point in the discussion. So let's jump right in.
The first study is the qualitative study of a mobile health exercise intervention focused on older adults with myeloid neoplasms. So in this study, a specific intervention from the University of Rochester, a home-based exercise program referred to as GO-EXCAP was applied to older adults to help prevent the decline of physical function and side effects, primarily fatigue, in patients with multiple myeloma. This is a mobile health application which is done in the home and is largely a qualitative study with people over the age of 60. The primary findings were that this intervention was found to be especially helpful for these patients over 60. It was easily applied in the home and could be used for 5 to 30 minutes 2 to 4 times per week. Patients were starting it at the beginning of their chemotherapy. They especially liked the instructions that were provided. Found it very easy to apply and were able to engage with their family and family members during the course of using this intervention. It does involve a web portal and requires a mobile device, so people need to have those. But the activity tracker that was used, which is a common one, was provided by the team. It looks like a very promising potential intervention, knowing how important exercise is, with some caveats on the use of technology for older patients.
Another study, a second study, is on the feasibility of doing a pragmatic geriatric assessment in a low-resource country, which is Brazil. So the goal of this study was not just to apply the geriatric assessment, which is known to be of importance for any older adult 65 and above with cancer, but to make it very practical and for use in an environment where you don't have all the resources you would have in an academic setting. So prior to an initial consultation, a nurse would apply the pragmatic geriatric assessment that included some very straightforward tests, ones that are recommended through the ASCO guidelines in 2018 and the SIOG guidelines that just came out. This was gait, speed test, a four-meter walk, a polypharmacy questionnaire, a mini nutritional assessment, a geriatric depression scale with 5 questions, and a mini COG, which is a small cognitive assessment for a few moments. They did this in a population of patients whose average age was 73 years old with a range from 61 to 93. And a number of findings. 39% of people were fit, but 22% were frail. With the rest, about 40%, in the prefrail state. A large majority, over 50%, were experiencing polypharmacy. 23% had depression. And 42% had concerns about cognitive impairments. We are able to show that even in a low-resource environment where it's typically difficult to apply a geriatric assessment this pragmatic assessment was able to be conducted, completed, and the major domains of a geriatric assessment were instigated. Significant numbers of deficits were found suggesting that interventions for these would be appropriately intervened on. And that would be the next step, is to show that we can use the known interventions to decrease the rates of these concerns.
The next abstract is 1 on the prevalence of geriatric syndromes in community-dwelling older adults. Geriatric syndromes are a common collection of concerns that older adults develop that cluster together and that tend not to happen in younger individuals. A good example is functional impairments, where the inability to do activities around the home is not possible for older adults. Falls is another common one, where multiple contributing causes lead to people falling a common outcome. Also, cognitive impairments among older adults is another geriatric syndrome. Again, this is an international study in Japan in which over 2,000 people over the age 65 and an average age of 72 were investigated for the prevalence of geriatric syndromes. A number of validated tests were applied to this group of patients and logistic regression was used to find those aspects that were most closely identified with having geriatric syndromes. Over 200 patients, about 10%, had a history of cancer. The prevalence of various outcomes, including physical impairments, depression, and kidney dysfunction, ranged from 4% up to 22%. In particular, the associations of physical impairments was about twofold higher in predicting the presence of a geriatric syndrome. And the community-dwelling older patient survivors had a high prevalence of these syndromes compared to elderly individuals without cancer, making the presence of cancer a concerning marker for the development of geriatric syndromes, even after cancer treatment when people are survivors.
And my last abstract of note was the use of extreme hypofractionation in stereotactic body radiation therapy in older patients with prostate cancer. So 179 patients over the age of 70 who were treated with radiation therapy for clinically localized prostate cancer had the EPIC-26 questionnaire which assesses a range of outcomes at multiple intervals over the next few months to years. And it was found that this extreme hypofractionation, or SBRT, stereotactic body radiation therapy, was very well tolerated in this older adult population with minimal numbers of side effects and led to excellent disease control over the first 3 years of treatment, making it a very well-tolerated and potentially best option for older adults with localized prostate cancer, especially those who have other comorbidities, other geriatric syndromes, and for whom disease control is appropriate. So those were the most important abstracts at the conference.
Next I'm going to move to a hematology study that was cited as the most important and potentially practice-changing published in Blood Advances by lead author Benjamin Derman and senior author Andrew Artz. In this study, a multidisciplinary clinic, guided by geriatric assessments, was used to optimize the care for older adults who are being considered for a hematologic bone marrow transplantation. Patients over 60 years old at a clinic at the University of Chicago had an evaluation of their candidacy for transplantation and then optimization of their care prior to and throughout the transplant process. This multidisciplinary assessment and optimization was conducted through patient surveys, on-site function and cognitive assessments, nutrition optimization, along with the participation of a multidisciplinary team that included PT and OT, a geriatric oncologist, the transplant physician, nutrition, infectious diseases, social work, and then a team discussion following a day evaluation.
This led to important improvements in transplant outcomes. And these outcomes improved over time, likely through a combination of better decision making about who receives the transplantation, those who are most fit going forth. And those who are most frail, perhaps offered other treatment options. This led to decreased deaths during an inpatient stay of transplantation, decreased nursing home admissions, decreased nonrelapse mortality, and increased survival, along with increased quality of life. This approach to older patients, who are now being increasingly considered for transplantation, does await formal randomized controlled trials to prove this approach is right. This was an observational trial but had quite a few patients and would indicate the value of having geriatric assessment-guided multidisciplinary team interventions.
So there's many other presentations and summaries in various fields at SIOG this year in both solid tumors and hematology, along with geriatrics in general. Please go to the SIOG 2020 website to get all the details and to read about more details from the abstract presentations and to see the presenters on the recordings. Thank you very much. And I look forward to seeing you all online.
ASCO: Thank you, Dr. Dale. You can find more research from recent scientific meetings at www.cancer.net. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play.
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