Role of Geriatric Intervention in Treatment of Older Patients With Cancer (PREPARE)

Phase 3

Active, not recruiting

• Conditions: Breast Cancer; Lung Cancer; Colorectal Cancer; Lymphoma; Bladder Cancer; Ovarian Cancer; Prostate Cancer
• Interventions: Other: Geriatrician Intervention

• Registration Number: NCT02704832
• Lead Sponsor: Institut Bergonié

Brief Summary

Randomized trials have already demonstrated that geriatric intervention was able to improve survival in the general elderly population but only a few have been performed in cancer patients. At the end, these data are not sufficient to consider geriatric intervention as validated in this setting. Case Management, coordinated by a geriatrician and a trained nurse, could improve prognosis of elderly patients with cancer. This approach, can be integrated in daily oncology practice. This strategy will be compared to usual oncological management in a randomized phase III trial.

Detailed Description

Patients will first be screened using the G8 screening tool. If the resulting score is altered (G8 \<= 14), patients will be included in the main study and randomized according to 2 modalities: Arm A / Usual care (treatment according to on-going regimens in oncology) or Arm B /Case management (assessment of the patient by the nurse and the geriatrician with interventions as prescribed by the geriatrician). The intervention will be considered effective if, at one year, compared to usual care there is a significant clinical improvement in overall survival (OS) without a significant deterioration or/and clinical improvement of at least one of the targeted quality of life (QoL) scores, without significant clinical deterioration in at least one of the targeted QoL scores and without significant difference in OS in favor of usual care.

If the resulting score is normal (G8 \> 14), patients will be treated according to their physician-in-charge opinion. A minimal set of data will be collected (age, sex, tumor type, disease stage, performance status (PS), creatinine clearance, albumin and C-Reactive Protein (CRP) levels mainly) to allow for the characterization of the population in order to compare our results to those of other published series.

Study Timeline

• Study First Submitted: 2016-02-19
• Study First Submitted QC: 2016-03-05
• Study First Posted: 2016-03-10
• Study Start: 2016-09-30
• Primary Completion: 2023-12-31
• Status Verified: 2024-11
• Last Update Submitted: 2024-11-15
• Last Update Posted: 2024-11-19
• Study Completion: 2026-03

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 792

Inclusion Criteria

1. Patient older 70 years and older

2. Performance status 0 to 3 (WHO)

3. G8 and QLQ-C30 questionnaires 'score are available

4. No previous geriatric evaluation during cancer treatment

5. Locally advanced or metastatic disease :

   1. 1st line medical treatment :

      • Breast cancer : locally advanced or metastatic disease, hormone-resistant and Her2 negative,
      • Colon and rectum : metastatic (unresectable metastasis),
      • Prostate cancer : metastatic and refractory to hormonal castration,
      • Bladder cancer : locally advanced or metastatic,
      • Ovarian cancer : advanced stage (IIb to IV),
      • Lung cancer : metastatic non-small cell,
      • Lymphomas (indolent and aggressive)

   2. Or 2nd line medical treatment :

      • Breast cancer : locally advanced or metastatic disease, hormone-resistant and Her2 negative,
      • Colon and rectum : metastatic (unresectable metastasis),
      • Prostate cancer : metastatic and refractory to hormonal castration,
      • Ovarian cancer : advanced stage (IIb to IV),
      • Lymphomas (indolent and aggressive)

6. Life expectancy over 6 months

7. Signed informed consent

8. Patients with a French social security in compliance with the French law relating to biomedical research (Article L.1121-11 of French Public Health Code).

Exclusion Criteria

1. Patient who already received 2 medical treatment lines

2. Exclusive 1st or 2nd treatment lines of :

   • Hormonotherapy (except for prostate cancer : abiteratone acetate is allowed),
   • Surgery,
   • Radiotherapy,

3. "Best supportive care" treatment

4. Patient unable to understand quality of life questionnaire

5. Patient unable to follow and comply with the study procedures because of any geographical, social or psychological reasons.

6. Patient placed under guardianship

7. Planned concomitant participation to another medical interventional trial during the 12 months following the inclusion in the randomized study PREPARE

8. Previous enrolment in the present study

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm B	Geriatrician Intervention	Arm B "Geriatrician Intervention": patients will be treated according to the same "Management protocol of Oncology" than patients in the arm "Standard oncological care". * Before the beginning of the medical treatment, a comprehensive geriatric assessment will be performed by the geriatrician and the nurse that will define a plan of geriatric management care, according to the "Management protocol of Geriatrics". * The nurse, under the supervision of a geriatrician, will monitor implemented geriatric interventions. Phone follow-up will be performed every month for 6 months and at 9 months or during any change of situation according to a pre-established phone call plan. A full geriatric assessment by the geriatrician and the nurse will be performed at 6 and 12 months.

Primary Outcome Measures

Name	Time	Method
Overall survival defined as the delay between randomization and death, all causes.	Year 1
Health related quality of life (HR-QoL) assessed using 3 scales of European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire.	Year 1

Secondary Outcome Measures

Name	Time	Method
Overall survival defined as the delay between randomization and death, all causes.	Year 3
Health related quality of life (hRQoL) assessed using 3 scales of EORTC QLQ-C30 questionnaire.	Year 3
For the experimental arm only: Assessment of autonomy using Activities of Daily Living (ADL) questionnaire.	Months 0, 6, 12
For the experimental arm only: Assessment of mobility using get-up and Go test.	Months 0, 6, 12
6-month response rates defined as per Response Evaluation Criteria In Solid Tumors (RECIST) v1.1 or Cheson criteria.	Month 6
Number of unscheduled hospitalizations.	up to 3 years
For the experimental arm only: Assessment of comorbidities using Cumulative Illness Rating Scale for Geriatrics (CIRS-G) scale.	Months 0, 6, 12
For the experimental arm only: Assessment of nutritional status using mini nutritional assessment (MNA) scale.	Months 0, 6, 12
Toxicity graded according to National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) v4.	up to 3 years
Length of unscheduled hospitalizations.	up to 3 years
For the experimental arm only: Assessment of autonomy using Instrumental Activities of Daily Living (IADL) questionnaire.	Months 0, 6, 12
For the experimental arm only: Assessment of depression using Geriatric Depression Scale (GDS-15) scale.	Months 0, 6, 12
For the experimental arm only: Assessment of cognitive functions using mini mental state exam (MMSE).	Months 0, 6, 12

Trial Locations

Locations (50)

Centre Hospitalier Universitaire de Lille; 🇫🇷 Lille, France

Clinique Mutualiste Eugène André; 🇫🇷 Lyon, France

Hôpital Saint Joseph Saint Luc; 🇫🇷 Lyon, France

Centre Léon Bérard; 🇫🇷 Lyon, France

Institut Paoli Calmettes; 🇫🇷 Marseille, France

Centre Hospitalier de Mont de Marsan; 🇫🇷 Mont de Marsan, France

Institut de Cancérologie de Montpellier; 🇫🇷 Montpellier, France

Institut de Cancérologie de Lorraine; 🇫🇷 Nancy, France

Centre Catherine de Sienne; 🇫🇷 Nantes, France

Centre Hospitalier Universitaire de Nîmes; 🇫🇷 Nîmes, France

AP-HP Hôpital Saint Louis; 🇫🇷 Paris, France

Centre Hospitalier de Pau; 🇫🇷 Pau, France

Hospices Civils de Lyon; 🇫🇷 Pierre Bénite, France

Centre CARIO - HPCA; 🇫🇷 Pleurin Sur Mer, France

Centre Hospitalier Universitaire de Poitiers; 🇫🇷 Poitiers, France

Centre Hospitalier René Dubos; 🇫🇷 Pontoise, France

Centre Hospitalier Annecy Genevois; 🇫🇷 Pringy, France

Polyclinique Francheville; 🇫🇷 Périgueux, France

Centre Hospitalier Intercommunal de Cornouaille; 🇫🇷 Quimper, France

Centre Jean Godinot; 🇫🇷 Reims, France

Centre Hospitalier Universitaire de Rennes; 🇫🇷 Rennes, France

Centre Eugène Marquis; 🇫🇷 Rennes, France

Centre Hospitalier Universitaire de Rouen; 🇫🇷 Rouen, France

Centre Hospitalier Privé de Saint Grégoire; 🇫🇷 Saint Grégoire, France

Centre Hospitalier Universitaire de Nantes; 🇫🇷 Saint Herblain, France

Centre Hospitalier de Saint-Malo; 🇫🇷 Saint-Malo, France

GHPSO Senlis Creil Picardie; 🇫🇷 Senlis, France

Centre Hospitalier Universitaire de Strasbourg; 🇫🇷 Strasbourg, France

Institut Claudius Regaud; 🇫🇷 Toulouse, France

Centre Hospitalier de Tourcoing; 🇫🇷 Tourcoing, France

Centre Hospitalier Universitaire de Tours; 🇫🇷 Tours, France

Centre Hospitalier Universitaire de Martinique; 🇫🇷 Fort De France, France

Centre Hospitalier Emile Roux; 🇫🇷 Le Puy-en-Velay, France

Centre Hospitalier Universitaire de Grenoble; 🇫🇷 Grenoble, Rhône Alpes, France

Institut de Cancérologie de l'Ouest; 🇫🇷 Angers, France

Centre Hospitalier de Beauvais; 🇫🇷 Beauvais, France

Institut Bergonié Centre Régional de Lutte Contre le Cancer; 🇫🇷 Bordeaux, France

CHU de Bordeaux; 🇫🇷 Bordeaux, France

Clinique Anne d'Artois; 🇫🇷 Béthune, France

Centre Hospitalier Universitaire de Caen; 🇫🇷 Caen, France

Infirmerie Protestante de Lyon; 🇫🇷 Caluire-et-Cuire, France

Centre Hospitalier Intercommunal de Castres Mazamet; 🇫🇷 Castres, France

Centre Hospitalier Métropôle Savoie Chambéry; 🇫🇷 Chambéry, France

Centre Hospitalier de Chinon; 🇫🇷 Chinon, France

Centre Hospitalier Universitaire de Clermont-Ferrand; 🇫🇷 Clermont-Ferrand, France

Centre Jean Perrin; 🇫🇷 Clermont-Ferrand, France

AP-HP Henri Mondor; 🇫🇷 Créteil, France

Centre Hospitalier Intercommunal de Créteil; 🇫🇷 Créteil, France

Centre Hospitalier de Dax; 🇫🇷 Dax, France

Centre Georges François Leclerc; 🇫🇷 Dijon, France