Prognostic awareness in older adults with metastatic cancer: Secondary analysis of a randomized controlled trial.

Abstract

1624 Background: Prognostic awareness plays a key role in patient outcomes, particularly among older adults with metastatic cancer. This secondary analysis of a randomized controlled trial (RCT) evaluated the effect of a Geriatric Assessment-guided Intervention (GAIN-S) on patient responses to prognosis items over time between two arms. Methods: Eligible participants, aged 65+, diagnosed with metastatic solid cancers, and undergoing treatment across multiple Brazilian states, were randomized 1:1 into two arms. The GAIN-S included a geriatric assessment (GA), which devised tailored treatment based on identified impairments. Patients in the usual care (UC) arm received standard care. Both arms completed the Illness and Prognostic Awareness Impact Questionnaire (PAIS) at baseline (T1) and 12 weeks (T2), assessing Emotional (10 items; range 0-30) and Adaptive (12 items; range 0-36) domains; each rated on a 4-point Likert scale The change in PAIS (T2 - T1) was calculated for each participant in both the GAIN-S and UC arms, and then the mean changes in PAIS between the two arms were compared via independent t-test. Results: Eighty-six patients were approached; 80 provided consent (93% enrollment rate). At 12 weeks, the analytic sample included 77 patients. Demographic characteristics were well-balanced between arms, with a mean age of 74.5 years (SD=6.1), primarily female (55.8%), self-identified as White (71.4%), and 50.4% had at least a college education. The most common cancer types were genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). At T1, no significant differences were noted in PAIS between arms. However, there was significant improvement in PAIS Emotional (UC: mean change=-0.26, SD=1.6 vs GAIN-S: mean change=0.87, SD=1.4; P=0.002) and Adaptive (UC: mean change=-0.07, SD=0.6 vs GAIN-S: mean change=0.74, SD=1.7; P=0.008) domains between in the GAIN-S arm (Table). Conclusions: This secondary analysis highlights the impact of GA-guided care on improving prognostic awareness in older adults with metastatic cancer. GAIN-S resulted in significant improvements in Emotional and Adaptive domains compared to UC. Tailored interventions addressing the specific needs of older adults with metastatic cancer may enhance understanding of prognosis and improve adaptive responses. Studies are needed to determine whether these differences translate into meaningful improvements in outcomes. Impact of GAIN-S intervention on prognostic awareness. Change over time Arm 1 (T2-T1)Mean (SD) Arm 2 (T2-T1)Mean (SD) DifferenceArm 2 - Arm 1 (SE) p-value Emotional Domain10 items (range: 0-30) -0.263 (1.62) 0.872 (1.44) 1.135 (0.35) 0.002 Adaptive Domain12 items (range: 0-36) -0.079 (0.67) 0.744 (1.73) 0.823 (0.30) 0.008