Presentation (CTI)

OBJECTIVES: Haematological malignancies predominantly affect older adults who face oncologic and geriatric challenges and receive prolonged chemotherapy. Comprehensive geriatric assessments (CGAs) may optimise treatment decisions and guide interventions to manage physiological decline. We evaluated effectiveness and cost-effectiveness of CGA-guided interventions for older haematological cancer patients.
METHODS: In a randomised controlled trial at a Singapore tertiary cancer centre, patients aged ≥65 years with haematological cancer and planned chemotherapy underwent frailty screening using the G-8 tool. Those eligible (G-8 score≥14) received CGAs and were randomised to CGA-guided multidisciplinary intervention or standard-care and followed-up for six months. Effectiveness outcomes were survival and health-related quality-of-life. Healthcare charges were collected for cost-effectiveness analysis. Survival was analysed using Cox proportional hazards models adjusted for diagnosis and risk scores. Healthcare utilisation was examined with logistic regression, quality-adjusted life-years (QALYs) gained with linear regression, and healthcare charges with gamma regression (log link). Multiple imputation addressed missing QALY data.
RESULTS: 88 intervention and 96 standard-care patients with balanced baseline characteristics were analysed. Intervention patients had longer median enrolment-to-death time (82 days, IQR 52-158) versus standard-care (38 days, IQR 24-75), and improved survival (HR=0.5; 95%CI 0.2-0.9; p=0.025). CGAs identified unmet onco-geriatric needs in 80% of intervention patients. Intervention participants were more likely to use dietetics (OR=2.1; 95%CI 1.0-4.4; p=0.042), physiotherapy (OR=2.1; 95%CI 1.0-4.3; p=0.044), or ≥1 CGA-guided service (OR=3.1; 95%CI 1.3-7.1; p=0.010). Adjusted analyses with imputed data showed higher intervention QALYs at 3-month (coef=0.04; 95%CI 0.02-0.07; p=0.002) and 6-month (coef=0.10; 95%CI 0.04-0.17; p=0.003). The intervention group had increased hospitalisations (OR=1.5; 95%CI 1.1-1.9; p=0.009) and ED visits at 6-month (OR=1.6; 95%CI 1.0-2.4; p=0.043), without differences in healthcare charges.
CONCLUSIONS: CGA-guided interventions improved survival and short-term QALYs and increased use of supportive services, without raising healthcare charges. Findings potentially support broader integration of geriatric screening in oncology care.