Multiple presentations at the recent American Society of Clinical Oncology (ASCO) virtual annual meeting focused on the implementation of geriatric oncology assessments for guiding the management of cancer patients.
In this exclusive MedPage Today video, Cary Presant, MD, of City of Hope Medical Center in California and a former ASCO director, discusses how conducting these assessments can change practice, and also highlights studies on cannabis and cannabidiol (CBD) interventions for side effects of treatment.
Following is a transcript of his remarks:
The other thing I wanted to talk about, which I think is changing my practice, is geriatric oncology assessments. You know, we’ve heard at these ASCO meetings for awhile that geriatric assessments can help to identify problems and difficulties that patients are getting into if they’re over the age of 65. The question is, does that make a huge, big difference in how these patients do? So there were a couple of presentations at the clinical science symposium. The first of them is abstract 12010 by Daneng Li, MD, who’s from City of Hope, where a lot of the geriatric oncology research has been centered.
And this was a very outstanding presentation. In this presentation, they had patients who were over age 65 — 600 patients randomized to getting a geriatric assessment and then getting detailed follow-up by social workers, by nurses, to make certain that any problems in their geriatric assessment were followed up versus getting the geriatric assessment and all they did was send it to the oncologist. So I’d get the geriatric assessment assuming that I know what to do with that, but without additional help to follow up on any problems that they’re seeing.
The results of this, I think, were really very interesting. The geriatric assessment program had a marked reduction in toxicity — 20% reduction in toxicity. A 10% reduction in hospitalization — that looked encouraging, but not statistically significant. But the decrease in toxicity means that older patients who are very vulnerable to the quality-of-life detriment of a side effect, they get fatigued and they’re in tough, tough shape. They get problems in eating, with nutrition, they get problems and nausea. These things are terrible with them and the geriatric assessment can predict who’s going to get in trouble. So the answer is, there are very brief geriatric assessments which you can do, make certain if you are an oncologist [that] you have resources like social workers, like good oncology nurses, advanced practice practitioners, who can follow up with your patients and make certain that the results of those geriatric assessments are implemented.
There was another study that was done at University of Rochester, which said exactly the same thing, that they had about a 25% reduction in toxicity. And I think all that’s important. The paper that just preceded this at ASCO was an abstract on cannabis use. And, you know, a lot of these patients that we’re seeing are having problems with nausea, vomiting, fatigue, things like that. And, this was a very well-defined, first really good study with oral cannabis combination of THC and CBD that they took versus placebo. So randomized, prospective trial, and the results were very interesting. No nausea [was] twice as common in the THC group, who took the combination of one-to-one THC CBD pills, not under-the-tongue pills. And, they had significant marked reduction, a 50% reduction in need for supplemental medications. So this was very important research.
There was also another abstract that was published, in print only, by [Shanmuga Subbiah, MD], also from City of Hope, E24143, where we were able to find that there was about a 25% usage of cannabis products by our patients. Many times they’re not telling the doctor that they’re using it, and therefore what happened to those patients when they were using the cannabis products, they have a 50% reduction in their subjective feelings of fatigue, nausea, low appetite. All of these things were extremely well benefiting the patients that we had.
So in the study that was done that was presented by [Peter Grimison, PhD], the first author on the abstract, 12008, that study significantly showed that patients preferred the THC/CBD to taking the placebo. And this preference shows us that we need to take this kind of information back with us. And if you’re in a state which has legalized medication, medical use of marijuana, THC, then this is very useful. Every state in the union is legal for CBD, so that can be taken. But it means that what I need to do now is I need to have more information myself that I can share with my patients on how you control toxicity. How do you control side effects, both with geriatric assessment and use of an intervention such as cannabis and CBD.
So, all in all, this has been an important meeting for me in terms of how I changed my practice. I’ll be sharing that with all my colleagues. And I hope that people who listen here will look up these abstracts, see if it really will change their practice and discuss those abstracts with other colleagues. This will improve practice, generally, for our patients. And the more that they benefit, the happier we are, the less stress in our lives, the markedly less stress in their lives.