Tailored follow-up does little to promote treatment adherence among elderly cancer patients

A tailored follow-up programme for frail and vulnerable elderly cancer patients does not appear to particularly improve the comprehensive geriatric assessment (CGA) in promoting treatment adherence, a recent study has found.

A total of 301 elderly cancer patients (median age, 75 years; 45 percent female) participated in the study and were randomly assigned to receive either a tailored follow-up by a multidisciplinary team or to a no-follow-up control group. The primary outcome was adherence to treatment, while secondary outcomes included physical performance, daily life activities, and hospitalization. All patients underwent CGA at baseline.

Completion rate was slightly higher for patients who received the follow-up intervention (61 percent vs 52 percent), though the resulting 90-day mortality was well-balanced between the groups.  The likelihood of study treatment completion was likewise statistically comparable between the two arms (risk rate [RR], 1.16, 95 percent confidence interval [CI], 0.95–1.42; p=0.14).

Signals for the comparative advantage of the tailored follow-up programme were detected when stratifying according to primary tumour site (p<0.01). Patients with lung and upper gastrointestinal cancers, for example, were more likely to complete treatment with the active intervention. In those with colorectal cancers, however, the control group performed slightly better.

Similarly, patients under palliative treatment were borderline more likely to complete treatment under the active intervention than with control (p=0.07).

None of the secondary endpoints were statistically impacted by the tailored follow-up programme.

The null findings “might be due to a dilution effect,” said researchers, explaining that the most important interventions to cancer had already been taken by participants in both study arms. “It is unlikely that a tailored follow-up could impact the tumour-related factors and this may also have diluted the results.”