Cristiane Decat Bergerot PhD, Paulo Gustavo Bergerot MD, Marianne Razavi PhD, Marcos Vinicius da Silva França MD, MS, Jonas Ribeiro Gomes da Silva BS, Jose Adolfo Cerveira MD, William Hiromi Fuzita MD, Gabriel Marques dos Anjos MD, Renata Ferrari BS, Errol J. Philip PhD, Mariana Tosello Laloni MD, Carlos Gil Moreira Ferreira MD, PhD, Marco Murilo Buso MD, Sumanta K. Pal MD, Ryan Nipp MD, MPH, Areej El-Jawahri MD, Enrique Soto-Perez-de-Celis MD, PhD, William Dale MD, PhD
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The authors evaluated whether GAIN-S enhances prognostic awareness among older adults with metastatic cancer in Brazil.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This randomized controlled trial was conducted in Brazil (June 2022–July 2023). Adults ≥65 years old with metastatic cancer were randomized 1:1 to GAIN-S (<i>n</i> = 39) or usual care (UC; <i>n</i> = 38). GAIN-S included multidisciplinary GA review, individualized care planning, and targeted referrals. UC consisted of standard care without GA-guided interventions. Prognostic awareness was assessed using the Prognostic Awareness Impact Questionnaire, covering emotional (10 items; range, 0–30), adaptive (12 items; range, 0–36), and cognitive (2 categorical items) domains. Group differences were analyzed using <i>t</i>-tests; item-level analyses used Mann-Whitney <i>U</i>, McNemar’s, or χ<sup>2</sup> tests.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Seventy-seven participants were enrolled (mean age, 74.5; 56% female). Common cancers included genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). GAIN-S led to greater improvements in emotional (mean difference = 1.14, standard error [SE] = 0.35, <i>p</i> = .002) and adaptive (mean difference = 0.82, SE = 0.30, <i>p</i> = .008) domains compared to UC. No differences were observed in the cognitive domain. Most participants reported their oncologist had not clearly stated whether their cancer was curable (74% GAIN-S vs. 57% UC). GAIN-S participants more often reported improved coping with prognostic uncertainty, better emotional acceptance, and reduced distress (all <i>p</i> < .05).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>GAIN-S improved emotional and adaptive domains of prognostic awareness. These novel findings underscore the value of the GAIN-S intervention for older adults. 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引用次数: 0
摘要
背景：老年评估（GA）引导的支持性护理（GAIN-S）可能改善老年癌症患者的决策，但其对预后意识的影响尚不清楚。作者评估了GAIN-S是否能提高巴西老年转移性癌症患者的预后意识。方法该随机对照试验于2022年6月至2023年7月在巴西进行。≥65岁的转移性癌症患者以1:1的比例随机分配到GAIN-S组（n = 39）或常规治疗组（n = 38）。GAIN-S包括多学科GA回顾、个体化护理计划和定向转诊。UC包括没有ga引导干预的标准护理。使用预后意识影响问卷评估预后意识，包括情绪（10项；范围，0-30），适应性（12项；范围，0-36）和认知（2个分类项目）领域。采用t检验分析组间差异；项目水平分析采用Mann-Whitney U检验、McNemar检验或χ2检验。结果共纳入77名受试者（平均年龄74.5岁，56%为女性）。常见的癌症包括泌尿生殖系统（29.9%）、乳腺癌（24.7%）和胃肠道（22.1%）。与UC相比，GAIN-S在情绪（平均差异= 1.14，标准误差[SE] = 0.35, p = 0.002）和适应（平均差异= 0.82,SE = 0.30, p = 0.008）领域有更大的改善。在认知领域没有观察到差异。大多数参与者报告说，他们的肿瘤学家没有明确指出他们的癌症是否可以治愈（GAIN-S占74%，UC占57%）。GAIN-S参与者更常报告改善了应对预后不确定性，更好的情绪接受，减少了痛苦（均p <； 0.05）。结论：GAIN-S改善了预后意识的情绪和适应性领域。这些新发现强调了GAIN-S干预对老年人的价值。需要研究来探索对决策、沟通和生活质量的长期影响。
The impact of a geriatric assessment-guided management intervention (GAIN-S) on prognostic awareness: A randomized controlled trial
Background
Geriatric assessment (GA)-guided supportive care (GAIN-S) may improve decision-making in older adults with cancer, but its effects on prognostic awareness remain unclear. The authors evaluated whether GAIN-S enhances prognostic awareness among older adults with metastatic cancer in Brazil.
Methods
This randomized controlled trial was conducted in Brazil (June 2022–July 2023). Adults ≥65 years old with metastatic cancer were randomized 1:1 to GAIN-S (n = 39) or usual care (UC; n = 38). GAIN-S included multidisciplinary GA review, individualized care planning, and targeted referrals. UC consisted of standard care without GA-guided interventions. Prognostic awareness was assessed using the Prognostic Awareness Impact Questionnaire, covering emotional (10 items; range, 0–30), adaptive (12 items; range, 0–36), and cognitive (2 categorical items) domains. Group differences were analyzed using t-tests; item-level analyses used Mann-Whitney U, McNemar’s, or χ2 tests.
Results
Seventy-seven participants were enrolled (mean age, 74.5; 56% female). Common cancers included genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). GAIN-S led to greater improvements in emotional (mean difference = 1.14, standard error [SE] = 0.35, p = .002) and adaptive (mean difference = 0.82, SE = 0.30, p = .008) domains compared to UC. No differences were observed in the cognitive domain. Most participants reported their oncologist had not clearly stated whether their cancer was curable (74% GAIN-S vs. 57% UC). GAIN-S participants more often reported improved coping with prognostic uncertainty, better emotional acceptance, and reduced distress (all p < .05).
Conclusions
GAIN-S improved emotional and adaptive domains of prognostic awareness. These novel findings underscore the value of the GAIN-S intervention for older adults. Studies are needed to explore longer-term effects on decision-making, communication, and quality of life.
期刊介绍：
The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society.
CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research
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