Improving cancer care for older adults: Updated results from a randomized clinical trial.
Bibliographic record
Abstract
3 Background: Undertreated cancer symptoms are common among older adults, yet effective early intervention remains limited. In prior work, our team developed a proactive symptom assessment approach to reduce unwanted hospital use among older adults with cancer. In a cohort study, we demonstrated the intervention association on reductions in acute care use and total costs of care. The effect at scale remains unknown. Methods: We conducted this multi-site randomized trial across 43 community-based oncology clinics in California and Arizona between November 2020 through October 2023 with 12 months follow-up. Medicare Advantage beneficiaries ages 75 years or older with newly diagnosed cancer who were planning to receive care at any of the clinics were eligible. Participants were consented and randomized 1:1 into a control group (usual care alone) or intervention group (usual care with LHW-led proactive, telephone-based weekly symptom assessments for 12 months using the Edmonton Symptom Assessment System) with planned enrollment of 200 in both groups. The LHW reviewed assessments with an advanced practice practitioner who conducted any necessary intervention for symptoms that changed by 2 points or were rated 4 or greater. Outcomes were determined a priori. The primary outcome was emergency department (ED) use and hospitalizations. Secondary outcomes included total costs, hospice, and, among decedents, acute care use within 30 days of death and facility deaths. Semi-structured 30 minute interviews were conducted with patients, caregivers, clinicians, and payer representatives to inform future adoption. Results: Among 416 patients (216 control; 200 intervention) median age was 82 years (range 75-99); 205 (49.3%) were Hispanic or Latino, 10 (2.4%) African American or Black, 3 (0.7%) American Indian or Alaska Native, 12 (2.9%) Asian, 4 (0.9%) Native Hawaiian, 2 (0.5%) Pacific Islander, 180 (43.3%) Non-Hispanic White, 20 (4.9%) with multiple races; 219 (52.6%) were male; 171 (41.1%) had stage 4 disease. Intervention group participants had 53% lower odds of ED use (OR: 0.47, 95% CI 0.37-0.62), 68% lower odds of hospital use (OR: 0.32, 95% CI 0.20-0.51), and lower mean total costs of care by $12,000 USD per participant (p = 0.01) than control group participants. Among 142 deceased (71 in each group) the intervention group had 68% lower odds of acute care (OR: 0.32, 95% CI 0.12-0.88) and 75% lower odds of a facility death (OR 0.25; 95% CI 0.08-0.77). Patients noted positive experiences with the intervention, caregivers noted lower caregiver-burden, clinicians noted efficiency in care due to the between-clinic intervention aspects, and payers noted return on investment. Conclusions: This intervention may be a scalable, value-based approach to reduce acute care use for older adults with cancer. Clinical trial information: NCT04463992 .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".