Telehealth Geriatric Assessment and Supportive Care Intervention (GAIN-S) Program: A Randomized Clinical Trial

Abstract

Background: Older patients with cancer face challenges in accessing high-quality cancer care, especially in resource-limited settings. We assessed the impact of a telehealth-adapted Geriatric Assessment-Guided Intervention (GAIN-S) among older Brazilians with metastatic cancer.

Patient and methods: This randomized clinical trial enrolled adults aged ≥65 years with metastatic cancer between June 2022 and July 2023. Patients were randomly assigned (1:1) to receive either usual care or GAIN-S. In the GAIN-S arm, a multidisciplinary team (MDT) developed an intervention plan based on impairments identified through geriatric assessment (GA). The plan included MDT discussions and targeted referrals to psychiatry, social services, nutrition, supportive care, and certified fitness training over a 3-month period. Assessments were conducted at baseline and at 3 months. The primary outcome was change in physical function, measured by instrumental activities of daily living (IADL) at 3 months. Secondary endpoints included changes in mood (assessed using the Geriatric Depression Scale [GDS]), quality of life (assessed using the Functional Assessment of Cancer Therapy-General [FACT-G]), and prognostic understanding. T tests and linear mixed models were used to compare groups at each timepoint and to assess longitudinal change.

Results: A total of 80 patients were enrolled (40 per arm). Clinical characteristics were well balanced between arms. Most patients were female (55.8%), with a mean age of 74 years (range, 65-88). At 3 months, patients in the GAIN-S arm showed improvements in physical function (IADL, +1.8), mood (GDS, -2.7), quality of life (FACT-G, +13.2), and symptom burden (assessed using the Edmonton Symptom Assessment System [ESAS], -14.6), all with P values <.001. Patients in the intervention group also demonstrated more accurate prognostic understanding (P<.01).

Conclusions: This study demonstrates the efficacy of the telehealth-administered GAIN-S intervention in older adults with cancer in Brazil. These findings underscore the importance of tailoring GA-guided interventions for resource-limited settings.