A Geriatric Oncology Collaborative Care Intervention for Older Adults With Advanced Cancer

Cancer disproportionately affects older adults, and the number of older adults with cancer is
expected to grow as the population ages. Older adults with advanced cancer often possess a
distinct set of medical and psycho-social issues that makes caring for the geriatric oncology
population challenging for oncologists. Currently, a critical knowledge gap exists regarding
how best to deliver comprehensive cancer care targeting the unique geriatric and palliative
care needs of these individuals. The investigators propose to develop a geriatric oncology
collaborative care intervention to improve supportive care outcomes for older adults with
advanced gastrointestinal (GI) and genitourinary (GU) cancer. GI and GU cancers are among the
leading causes of cancer death in the geriatric cancer population, and patients with advanced
GI and GU cancers experience a high symptom burden. The intervention will entail visits with
an oncology advanced practice nurse trained to address patients' unique needs, who will meet
regularly with a supervising team of geriatric, palliative care, social work, and pharmacy
clinicians for feedback and iterative reevaluation of the care plan. Using nurses who are
already integrated into the oncology setting represents a scalable model that addresses the
workforce shortage of geriatric and palliative care clinicians. The investigators used
conceptual models for collaborative care and geriatric interventions to develop an initial
intervention framework, and prior research to develop a preliminary intervention manual. In
Aim 1, the investigators will refine and finalize both the intervention and the intervention
manual based on qualitative data from patients, caregivers, and clinicians to ensure the
intervention targets the unique needs of older adults with advanced cancer. In Aim 2, the
investigators will modify the intervention and study methods with an open pilot study (n=10).
In Aim 3, the investigators will conduct a pilot randomized trial (n=75) to assess the
feasibility and preliminary efficacy of the geriatric oncology collaborative care
intervention for improving patients' QOL, symptom burden, and functional outcomes.

Inclusion Criteria:

- Age 70 or older

- Diagnosed with advanced (defined as metastatic or receiving therapy with palliative
intent) esophageal, gastric, pancreas, hepatobiliary, colorectal, renal, bladder, or
prostate cancer within the past 8 weeks (includes patients with a new diagnosis,
progression or recurrence).

- ECOG performance status of 0-2

- Ability to read and respond to questions in English

- Planning to receive care at MGH

Exclusion Criteria:

- Uncontrolled psychiatric illness or impaired cognition