Commentary

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Advancing Geriatric Oncology Care Through Telehealth and the GAIN-S Model: Dr William Dale

Within the GAIN-S model, geriatric care assessments among older patients with cancer are combined with care interventions, and it is delivered soon before patients have an intervention on their cancer therapy, says William Dale, MD, PhD, FASCO, City of Hope.

William Dale, MD, PhD, FASCO, vice chair for academic affairs, Department of Supportive Care Medicine, and director, Center for Cancer and Aging, City of Hope is senior author of 2 abstracts presented at the 2024 American Society of Clinical Oncology annual meeting: “Geriatric assessment–directed supportive care intervention (GAIN-S)-implementation via telehealth in a lower-resourced community,” and “Quality of life for older patients with metastatic cancer in Brazil: A telehealth-based geriatric assessment and supportive care intervention (GAIN-S).”1,2 He is also the recipient of this year’s B.J. Kennedy Geriatric Oncology Award, a lecture he delivered on Friday, the first nononcologist so honored.

Here he goes into detail on the GAIN-S model and the advantages of telehealth among older patients who have cancer.

“It was a really good option, because it got to where they were,” he says. “And once we could get people connected through everything, it was a great way to both see them and see them where they were in their house.

Transcript

Can you describe the elements of the GAIN-S model?

This grew out of the desire to take the development a geriatric assessment and turn it into geriatric assessments plus interventions. That's the “IN” part of GAIN, geriatric assessment and interventions. So how do you partner an intervention approach with the assessment approach? Up til we developed this model of an intervention, we had predictive ability with geriatric assessment and we had the idea that we could intervene, but whether we could affect outcomes meaningfully was the big question as is often the case in this kind of research—that's hard to prove that you can make a difference on big outcomes. So, our approach was to take the standardized and validated geriatric assessments and partner that with interventions matched to the dimensions on the geriatric assessment.

Very concisely, we have what we consider the essential domains for geriatric assessments—functional, cognition, social, nutrition—and for each one, we say, “If this is found to be abnormal, do this,” right? And whatever this is, might be, if you have a mobility problem, you would do physical therapy. If you were having a nutrition problem, you would see a nutrition person. And then sometimes they're more specifically things you can do kind of counseling-type things, let's say, for mental health support, if you can't immediately get a referral for mental health. So that's the model, and it's targeted to be delivered to people right before they have an intervention on their cancer therapy—usually chemotherapy, sometimes immunotherapy—and we believe, and there's evidence to support in other studies, surgery or radiation would be equally valuable interventions that you would partner this with.

Why is telehealth a good delivery option for supportive care for older patients with cancer?

So, 2 things are the case. In the original GAIN model, we delivered it in person. Someone was seen, we had someone there, we made sure they saw them. So the big question at the time that we started developing these studies was, could you translate that into some other venue and get it to patients who are “out in the real world.” So 20% of people are in those NCI [National Cancer Institute]–designated cancer centers who have cancer, 80% are out someplace else. And so, how do you do that was the question. We and others had decided, well, let's try telehealth. Can we can we reach out through telehealth and did some initial preliminary work. Just about that time the pandemic hit, as we were trying to figure out whether this could work. And in a weird way, in the academic world, everybody just started doing telehealth in the middle of us trying to understand if it was going to work. So we benefited, in a way, from having the opportunity to try telehealth in real time while we were studying whether it was working.

You asked why is it a good option or not? The first instinct people had is, older people are going to have trouble with technology, so are we really going to trust that they could use technology? And it's true, just like all of us, they have trouble with technology, too, but it's not that much different than the rest of us have trouble with technology, as it turns out. With the forced need to do telehealth, we all sort of learned on the fly. And so in one way, there's the technology challenge—and they do need support like others—but in terms of reaching out to people, we realized it was a really good option because it got to where they were. And once we could get people connected through everything, it was a great way to both see them and see them where they were in their house. So I couldn't do a physical exam, but you could actually see things about where they lived, where their medicines were being stored, what their house looked like, tripping hazards. You sometimes would even see on the video or whatever it was, who was around. They would call somebody and say, “Hey, could you go get my medicine bottle and bring it so I can show the doctor?” So in many ways it was advantageous.

The other advantage, as I'm sure you've recognized, is the convenience for people so the chance that they'd actually come to a visits went up a lot. And speaking of the Brazil experience, we have really good examples where they would just never get anything like this kind of care, given their circumstances if you didn't have a telehealth option to connect with people. And so the benefits, in my opinion, far outweigh the downsides of you're not in person and you're not going to get to do physical exam in that encounter. That has to be done in some other way.

References

1. Phillips T, Sun CL, Chien LC, et al. Geriatric assessment–directed supportive care intervention (GAIN-S)-implementation via telehealth in a lower-resourced community. Presented at: ASCO 2024; May 31-June 4, 2024; Chicago, IL. Abstract 1510. https://meetings.asco.org/2024-asco-annual-meeting/15679?presentation=231568#231568

2. Bergerot CD, Bergerot PG, Razavi M, et al. Quality of life for older patients with metastatic cancer in Brazil: A telehealth-based geriatric assessment and supportive care intervention (GAIN-S). Presented at: ASCO 2024; May 31-June 4, 2024; Chicago, IL. Abstract 1514. https://meetings.asco.org/2024-asco-annual-meeting/15861?presentation=232492#232492

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