DISCUSSION
tumor, dyspnea, fatigue, toxicities, pain, insomnia, small-cell lung cancer
ADVANCED CANCER, TUMOR
These analyses address important gaps in understanding the symptom experience of older adults with advanced cancer receiving systemic therapy. First, Gap70+ is the first nationwide cluster-randomized trial to demonstrate that a GA intervention can decrease patient-reported symptomatic toxicities. Second, the findings establish high baseline symptom burden and a high prevalence of developing new or worsening symptomatic toxicities over 6 months. Third, to our knowledge, it is the first study to systematically describe baseline symptom burden as measured by PRO-CTCAE in older adults with advanced cancer. Fourth, this study is one of a very few to report patient-reported symptomatic toxicities as an outcome in a randomized controlled trial. Previously, PRO-CTCAEs were evaluated in trials examining the efficacy of therapeutic agents in advanced prostate cancer and non–small-cell lung cancer.These results provide further support for GA-based models of care.Symptomatic toxicities were highly prevalent in both arms over 6 months. At baseline, patients had a high prevalence (86%) of having at least one moderate to severe symptom, and also the majority (92%) experienced worsening or new symptomatic toxicities. Given that an important treatment goal in the advanced cancer setting is to decrease tumor burden and improve symptom control,The specific symptoms of fatigue, pain, insomnia, decreased appetite, and dyspnea were reported by more than 50% of older adults before treatment initiation. These results align with past research on commonly experienced symptom prevalence in individuals of all ages with advanced cancer.Ongoing efforts are underway to determine best approaches for analyzing and reporting PRO-CTCAE data.There were several study limitations. The sample was primarily White, limiting generalizability. The selected time intervals were a limitation since the PRO-CTAE items were not collected weekly, and thus may not have captured the period when symptomatic toxicities were present or most severe.This analysis provides evidence that a GA intervention can decrease the prevalence of symptomatic toxicities as measured by patient-reported outcomes. Future trials should examine whether GA-based models of care that integrate symptom monitoring and management can further improve outcomes of older patients with advanced cancer and aging-related conditions.