Primary care implementation of a cross-sector geriatric assessment with management intervention for older patients undergoing radiotherapy.

PURPOSE: Geriatric Assessment with Management (GAM) is recommended for older patients with cancer. We evaluated the primary care implementation of a cross-sector GAM intervention for patients receiving radiotherapy. METHODS: GAM was initiated in hospital at the start of radiotherapy with subsequent weekly follow-up and symptom assessments by designated primary care nurses. This pre-planned feasibility assessment was performed using the Reach, Adoption, and Implementation domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. RESULTS: Eighty-nine patients (mean 74.2 years) from 14 primary care districts received the intervention. Post-radiotherapy, most were reached by the scheduled follow-up. Primary care involvement during the intervention mainly involved cancer nurses. Of 18 participating nurses, eight worked alone, 11 had part time positions and three were allocated to other tasks after the Covid-19 outbreak. Post-radiotherapy, 80% of scheduled symptom registrations were completed, 53% during treatment. New measures were documented for 7/12 patients reporting severe pain, 6/22 patients at risk of malnutrition, and for 3/23 and 9/37 patients with cognitive- or functional impairments, respectively. CONCLUSION: Factors potentially contributing to suboptimal intervention implementation were lacking administrative and collegial support, system integration, geriatric competence and local ownership, as well as cancer nurses facing challenging working conditions. Further research is needed to optimize cross-sector GAM for radiotherapy patients. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03881137.