Need and uptake of geriatric assessment-guided interventions in older Indian patients with cancer: A cross-sectional...

Studies on the requirement and utilization of geriatric assessment (GA)-guided interventions are scarce, especially from low- and middle-income countries. We aimed to evaluate the number of referrals generated following the GA, uptake of GA-guided referrals for interventions in older patients with cancer, and factors influencing patient compliance.

This was a cross-sectional analytical study conducted in the geriatric oncology clinic of the Department of Medical Oncology at the Tata Memorial Hospital in Mumbai, India between June 2018 and July 2023. Participants underwent GA before starting systemic cancer-directed therapy, with referrals to various healthcare professionals based on vulnerabilities identified through the GA. Baseline patient-, tumor-, and GA-related data were collected, along with data on GA-guided referrals made and compliance to these referrals. Statistical analysis included regression models to identify factors associated with low compliance with GA-guided referrals focusing on demographic and clinical variables, and vulnerabilities in the GA.

We enrolled 2544 older patients with cancer who had undergone a GA during the timeframe of the study. There were 2353 (92.5%) patients who were referred to at least one specialist after their GA, and 1750 (74.4%) patients attended at least one referral. The median number of referrals attended per patient was 50% (IQR, 0-75). Overall, only 2954 (44.8%) of the total 6594 GA-guided referrals made were attended collectively by the entire cohort of patients. The highest referral uptake was for dieticians (73.7%), and the lowest for general physicians (19.8%). Referral uptake for other interventions was 44.8% for physiotherapists, 30.3% for occupational therapists, and 27% for psychologists/psycho-oncologists. Factors associated with lower uptake of referrals were fatigue (OR = 1.49 [95% CI, 1.23-1.81]), depression (OR = 1.31 [95% CI, 1.07-1.59]), comorbidities (OR = 1.24 [95% CI, 1.03-1.49]), and palliative-intent therapy (OR = 1.57 [95% CI, 1.3-1.9]), while poor nutrition was associated with greater uptake of referrals (OR = 0.42 [95% CI, 0.32-0.55]).

There is a substantial gap between the need for and the uptake of GA-guided interventions among older Indian patients with cancer. Focused efforts need to be made to bridge this gap to realize the benefits of the GA and optimize oncologic outcomes in older patients with cancer.