Rachelle Brick PhD, MSPH, OTR/L, Marielle Jensen-Battaglia PT, DPT, Brennan P. Streck PhD, RN, MPH, Lindsey Page PhD, MPH, Rachael Tylock MS, Jenna Cacciatore MS, Karen Mustian PhD, MPH, Jamil Khatri MD, Jeff Giguere MD, Elie G. Dib MD, MS, Supriya Mohile MD, MS, Eva Culakova PhD, MS
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The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, <i>p</i> = 0.01), Karnofsky score indicating disability (OR = 2.86, <i>p</i> < 0.01), and receipt of monoclonal antibodies (OR = 1.95, <i>p</i> = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, <i>p</i> < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, <i>p</i> = 0.07) and IADL (OR 0.64, <i>p</i> = 0.35), but more likely to decline in HRQoL (OR 1.20, <i>p</i> = 0.67) and have worse survival (HR 1.18, <i>p</i> = 0.62).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"136-149"},"PeriodicalIF":4.3000,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exploring geriatric assessment-driven rehabilitation referral patterns and its influence on functional outcomes and survival in older adults with advanced cancer\",\"authors\":\"Rachelle Brick PhD, MSPH, OTR/L, Marielle Jensen-Battaglia PT, DPT, Brennan P. 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In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, <i>p</i> < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, <i>p</i> = 0.07) and IADL (OR 0.64, <i>p</i> = 0.35), but more likely to decline in HRQoL (OR 1.20, <i>p</i> = 0.67) and have worse survival (HR 1.18, <i>p</i> = 0.62).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. 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引用次数: 0
摘要
背景：晚期癌症患者中的老年人会出现功能障碍，需要接受康复服务；但有证据表明，转诊情况并不一致。研究目的是：(1) 确定老年评估（GA）驱动的康复服务转介的预测因素；(2) 探讨转介与晚期癌症老年人的功能变化、健康相关生活质量（HRQoL）和总体生存率之间的关系：这是一项全国性 GA 临床试验的二次分析（NCT020107443，UG1CA189961）。患者为晚期癌症老年人，至少有一项 GA 定义的身体表现或功能状态损伤。主要研究结果包括：GA后由肿瘤学家发起的关于康复服务的讨论或转诊（目标1）、3个月内日常生活活动（ADL）、工具性日常生活活动（IADL）和HRQoL的下降以及1年后的总生存率（探索性目标）。分析包括多变量逻辑回归和考克斯比例危险模型。人口统计学和临床因素通过1:1倾向评分匹配进行控制：共对 265 名患者进行了分析。经调整后，认知能力受损（几率比 [OR] = 2.25，P = 0.01）、Karnofsky 评分显示残疾（OR = 2.86，P 结论：这两个因素均与癌症治疗、多药治疗和药物滥用有关：癌症治疗、多药治疗、认知能力和残疾状况可能会影响肿瘤专家转诊康复的决定。转诊与功能性残疾、HRQoL 或生存率的变化并无独立关联。未来的研究应评估患者在转诊后对康复服务的利用情况，并确定康复服务的剂量/时间是否会影响临床结果。
Exploring geriatric assessment-driven rehabilitation referral patterns and its influence on functional outcomes and survival in older adults with advanced cancer
Background
Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer.
Methods
This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching.
Results
In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, p = 0.01), Karnofsky score indicating disability (OR = 2.86, p < 0.01), and receipt of monoclonal antibodies (OR = 1.95, p = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, p < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, p = 0.07) and IADL (OR 0.64, p = 0.35), but more likely to decline in HRQoL (OR 1.20, p = 0.67) and have worse survival (HR 1.18, p = 0.62).
Conclusions
Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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