Feasibility and Effectiveness of Automated Geriatric Co-Management Program on Improving the Perioperative Care of Older Lung Cancer Patients

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ABSTRACT: The purpose of this project is to improve the perioperative outcomes of older lung cancer patients. Every year, 120,000 patients age 65 or older every year are diagnosed with lung cancer. Surgery offers the highest likelihood of cure to early-stage lung cancer patients. However, older frail cancer patients are at a higher risk for adverse surgical outcomes & slow functional recovery compared to younger and older fit lung cancer patients. One study showed that 5.6% of frail patients died after lung surgery compared to just 1% of fit patients. Frailty can be assessed by Geriatric Assessment (GA). However, GA without proper interventions to manage the identified age-related impairments will not improve outcomes. In the non-oncologic setting, collaboration between surgeons and geriatricians has improved surgical outcomes. In a study of 319 orthopedic patients, in-hospital mortality decreased from 5.8% to 0.6% following such collaboration. As a result, collaboration between surgeons and geriatricians is becoming the standard for improving surgical outcomes of older patients. However, with only 7000 geriatricians practicing in the US, such collaboration between thoracic oncology surgeons and geriatricians may not always be feasible. In an attempt to address this need, in 2015, we developed and implemented an electronic Rapid Fitness Assessment (eRFA), a web- based GA, in our institution. The Memorial Hospital Thoracic Service has implemented the eRFA in their clinics as a point of care. Moving ahead with the need to intervene based on GA, our scalable solution is to provide thoracic surgeons with an Automated Geriatric Comanagement Program. Following completion of the eRFA by the patients, the Program summarizes the identified impairments and provides recommendations that were developed based on published guidelines, and our geriatric expertise. The primary aim of our current study is to test the feasibility & acceptability of this Program. We will deem the Program feasible if surgical teams follow at least 50% of recommendations in at least 70% of patients. The program will be considered acceptable if 80% of surgeons & nurses have high/very high satisfaction with the Program. By performing a randomized controlled trial on 200 lung cancer patients age 65+, we aim to collect preliminary data on the difference between adverse surgical events & postoperative functional recovery of patients in the automated geriatric comanagement program group vs. collaboration between surgeons & geriatricians. Functional recovery will be assessed by patient-reports on Karnofsky performance scale (KPS), basic & instrumental activities of daily living (bADL, iADL), by Timed Up & Go (TUG), & 6Minute Walk test (6MWT), two weeks after hospital discharge. Finally, we will explore the possibility of using wearable devices measuring activity as an alternative way to collect objective data rather than KPS,bADL,iADL, TUG & 6MWT. We will use this data as the foundation for a fully powered multi-institutional R01 study on the effectiveness of automated-Geriatric Comanagement Program on improving surgical outcomes & functional recovery of older lung cancer patients.