Leveraging Data Linkages to Evaluate the Effects of a Geriatric Assessment Oncology Care Model in Older Adults with Advanced Cancer - PROJECT SUMMARY: A Geriatric Assessment (GA) oncology care model improves outcomes for older adults with cancer by optimizing treatment decisions. The GA oncology care model uses validated tools to identify aging-related health impairments (e.g., comorbidities, cognitive decline) that increase the risk of cancer treatment side effects (i.e., toxicity). The GA oncology care model facilitates early identification of aging-related toxicity risk factors to allow oncology teams to proactively implement targeted interventions to reduce toxicity risk. This results in lower cancer treatment toxicity and possibly lower reactive healthcare utilization, such as unplanned hospitalizations and Emergency Department visits, to care for treatment toxicity. This proactive approach may also increase the time older patients with cancer can spend at home (i.e., “home time”), which older adults value for independence, social activity, and improved mood. Our team developed and tested a scalable GA oncology care model where patients complete most of the GA, with thresholds guiding evidence-based recommendations to reduce aging-related toxicity risk. The GA oncology care model has been shown to reduce treatment toxicity and improve patient-clinician communication, often leading to less intensive treatments without compromising survival. It may also reduce cancer care costs by minimizing reactive utilization, such as hospitalizations for treatment toxicity. However, the impact of GA on healthcare utilization and economic outcomes in the U.S. remains unclear. Supported by the National Institute on Aging LINKAGES Program, we can link data from our two major trials evaluating GA oncology care with Centers for Medicare and Medicaid Services utilization and cost data. Our trials (NCT02107443, NCT02054741) enrolled older adults with advanced cancer nationwide, randomizing practices to GA oncology care or usual care. While clinical outcomes were assessed, detailed utilization and cost data were not collected. The overarching goal of this proposal is to investigate the impacts of a GA oncology care model versus usual care for older adults with advanced cancer on healthcare utilization, home time, costs, and cost-effectiveness. We hypothesize the GA oncology care model will have higher proactive healthcare utilization and costs yet lower reactive toxicity- related utilization and costs, resulting in increased home time, lower total cost, and favorable cost- effectiveness versus usual care. Using the novel data linkage, we aim to evaluate patterns of healthcare utilization under the GA oncology care model vs usual care, including characterizing proactive healthcare utilization (Aim 1a), reactive healthcare utilization (Aim 1b), and estimating the effect of the GA oncology care model versus usual care on home time. Additionally, we will assess the cost and cost-effectiveness of the GA oncology care model versus usual care (Aims 2a and 2b). Our findings will inform healthcare organization and payer policies to implement GA oncology care for >1 million older Americans diagnosed with cancer annually.
