Feasibility of an integrated aging assessment for cancer patients in oncology clinics.

Abstract

e13593 Background: Older adults living with cancer navigate complex medical, psychosocial, and environmental needs – which are challenging to identify and address in clinical care. Patient-completed screening tools pose an opportunity to proactively uncover geriatric syndromes, high-risk behaviors, and patient concerns. We evaluated the feasibility and potential impact of one such screening tool given prior to an initial oncology visit - the Integrated Aging Assessment questionnaire (IA3). Methods: In a pilot feasibility study, older patients (≥65 years) presenting for a new patient visit in the University of Colorado Breast or Genitourinary oncology clinics completed the IA3. This web-based tool includes validated screening items and provides risk assessment and structured feedback for oncologists and patients across a spectrum of “whole person health” domains: geriatric frailty, health behaviors (diet, activity, sleep, tobacco, alcohol), mental health, and social needs (e.g., transportation). We used co-creation partner engagement strategies to work with patients, clinicians, operational leaders, and staff in developing workflows to implement the IA3. Post-visit questionnaires assessed patient-reported acceptability in terms of incorporation of IA3 into the visit, discussion of patient-prioritized concerns, perceptions of whole-person care; and oncologist-reported utility. Results: Thirteen patients completed the IA3 tool. The most common elevated risks (medium or high) were diet-related concerns (11/13), excessive daytime sleepiness (8/12), and low physical activity (7/12), followed by tobacco or alcohol use (5/13) and mental health concerns (3/13). Few patients screened as medium or high risk for loneliness or social isolation (2/12), financial insecurity (1/12), or housing instability (1/12). Only 1 of the participants screened as potentially frail in the geriatric health screen. Despite low overall risk profiles, all patients screened positive in at least one actionable domain (13/13). Most participants reported that the IA3 was incorporated into the clinic visit (11/12). Specifically, patients reported oncologists considered multiple dimensions of health (11/11) and discussed the patient’s prioritized IA3 issues (12/12). Oncologists indicated that IA3 influenced the care plan in 30.7% of visits and rated the IA3 as modestly helpful to the visit (5.3/10 [SD1.4]). Conclusions: The IA3, a patient completed health assessment, performed prior to an initial visit was acceptable to patients and feasibly integrated into clinic workflows. Oncologists noted modest helpfulness and did not object to its use. Future work may focus on clinic integration as the IA3 has the potential to enhance patient centeredness of oncology visits, and to connect vulnerable older patients with prioritized resources early in their cancer care trajectory. Clinical trial information: NCT05871008 .