Effectiveness of a Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy Toxicities in Elderly Cancer...

Elderly patients with cancer are highly vulnerable to severe chemotherapy-related toxicities due to age-related physiological decline, multimorbidity, and frailty. Standard performance scales like the Eastern Cooperative Oncology Group (ECOG) are often insufficient for assessing this risk. The Cancer and Aging Research Group (CARG) score is a validated tool for predicting chemotherapy toxicity, while the Geriatric Assessment-Driven Intervention (GAIN) model provides a structured, multidisciplinary framework to mitigate these risks.

This study aimed to evaluate the effectiveness of the GAIN model in reducing the incidence of severe (grade ≥3) chemotherapy-related toxicities in elderly cancer patients. Secondary objectives included assessing the impact of GAIN on treatment continuity, hospitalization rates, and emergency department visits.

A prospective, randomized controlled interventional study was conducted over six months in the oncology department of Employees' State Insurance Corporation (ESIC) Medical College and Post Graduate Institute of Medical Sciences and Research (PGIMSR), a tertiary care hospital in Bengaluru, India. Seventy patients aged 60 years or older with solid tumors initiating chemotherapy were enrolled and allocated to either the GAIN arm (n=35) or the Standard of Care (SOC) arm (n=35). All patients underwent a baseline comprehensive geriatric assessment, and their CARG toxicity risk score was calculated. Patients in the GAIN arm received individualized interventions from a multidisciplinary team (MDT) based on identified vulnerabilities. The SOC arm received routine oncological care. The primary outcome was the incidence of grade ≥3 chemotherapy-related toxicities, graded using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0.

The incidence of grade ≥3 chemotherapy-related toxicities was significantly lower in the GAIN arm, with 17 of 35 patients (48.6%) experiencing severe toxicity compared to 26 of 35 patients (74.3%) in the SOC arm (p=0.027). Patients in the GAIN arm also had numerically fewer unplanned hospitalizations (14, 40% vs. 17, 48.6%), emergency department visits (14, 40.0% vs. 16, 45.7%), chemotherapy dose modifications (four, 11.4% vs. eight, 22.9%), and early treatment discontinuations (four, 11.4% vs. eight, 22.9%), though these differences were not statistically significant.

The integration of a GAIN significantly reduces the incidence of severe chemotherapy-related toxicities in elderly cancer patients.