***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The aim of this study was to assess the prevalence of potentially inappropriate medication ( PIM ) use upon admission and at discharge in a geriatric oncology unit after involving a clinical pharmacist . Although the few studies conducted in geriatric oncology units used the 2003 Beers criteria , this study used START and STOPP criteria , a more appropriate tool for European formularies . MATERIAL S AND METHODS Prospect i ve study in older ( ≥70years ) patients consecutively admitted to a geriatric oncology unit in a cancer center from July 2011 to April 2012 .  Clinical pharmacist conducted a complete comprehensive medication review including non-prescription and complementary ( herbals ) medications . This information coupled with the patient 's medical history allows identifying PIMs using the STOPP and START criteria . The number of PIMs at admission and at discharge from the hospital was compared after clinical pharmacist intervention . RESULTS Ninety-one older patients with cancer ( mean age±SD=79±6years ) were included in the study . START criteria identified 41 PIMs for 31 persons ( 34 % ) at admission compared to 7 PIMs for 6 persons ( 7 % ) at discharge . STOPP criteria identified 50 PIMs at admission for 29 persons ( 32 % ) compared to 16 PIMs at discharge for 14 persons ( 16 % ) . Results showed significantly lower START scores at discharge than at admission ( p<0.001 ) ; similarly , STOPP criteria demonstrated fewer PIMs at discharge than at admission ( p<0.001 ) . CONCLUSION The use of START and STOPP criteria by a clinical pharmacist allows identifying PIMs and changing prescriptions for older patients with cancer in agreement with the oncologist and geriatrician of the team Background Depression is common among older cancer patients , but little is known about the optimal approach to caring for this population . This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment ( IMPACT ) program , a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis . Methods Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study . Subjects were 60 years or older with major depression ( 18 % ) , dysthymic disorder ( 33 % ) , or both ( 49 % ) , recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states . Patients were r and omly assigned to the IMPACT intervention ( n = 112 ) or usual care ( n = 103 ) . Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education , care management , support of antidepressant management , and brief , structured psychosocial interventions including behavioral activation and problem-solving treatment . Results At 6 and 12 months , 55 % and 39 % of intervention patients had a 50 % or greater reduction in depressive symptoms ( SCL-20 ) from baseline compared to 34 % and 20 % of usual care participants ( P = 0.003 and P = 0.029 ) . Intervention patients also experienced greater remission rates ( P = 0.031 ) , more depression-free days ( P < 0.001 ) , less functional impairment ( P = 0.011 ) , and greater quality of life ( P = 0.039 ) at 12 months than usual care participants . Conclusions The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care setting BACKGROUND Geriatric assessment has been suggested as a possibly useful approach in dealing with frail elderly cancer patients . METHODS This was a secondary subset analysis from a r and omized 2 x 2 factorial trial in 11 Department of Veterans Affairs medical centers . Hospitalized , frail patients at least 65 years old , after stabilization of their acute illness , were r and omized to receive care in a geriatric inpatient unit , a geriatric outpatient clinic , both , or neither .  The interventions involved core teams that provided geriatric assessment and patient management . We identified 99 patients with a diagnosis of cancer by The International Classification of Diseases , 9th Revision ( ICD-9 ) codes , excluding all nonmelanoma skin cancers . Outcomes collected at discharge , 6 months , and 1 year after r and omization were survival , changes in health-related quality of life ( using the Medical Outcomes Study 36-Item Short-Form general health survey [ SF-36 ] ) , activities of daily living , physical performance , health service utilization , and costs . RESULTS There was no effect on mortality ( 1-year survival 59.6 % ) . The changes in the SF-36 scores from r and omization for emotional limitation , mental health and bodily pain ( also sustained at 1 year ) on the SF-36 were better for geriatric inpatient care cancer patients at discharge . There was no difference in SF-36 scores between geriatric outpatient and usual outpatient care . Days of hospitalization and overall costs were equivalent for the interventions and usual care over the 1-year study . CONCLUSIONS This study suggests that inpatient geriatric assessment and management may be an effective approach to the management of pain and psychological status in the elderly cancer inpatient at no greater length of hospitalization or extra cost than usual care Background Disadvantaged population s face many barriers to cancer care , including limited support in navigating through the complexities of the healthcare system . Family members play an integral role in caring for patients and provide valuable care coordination ; however , the effect of family navigators on adherence to cancer screening has not previously been evaluated . Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients . Methods Guided by principles of community based participatory research ( CBPR ) , “ Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors ( COACH ) ” is a community-based r and omized controlled trial to assess the effectiveness of a trained participant- design ated coach ( support person or care giver ) in navigating cancer-screening for older African American adults , 50–74 years old . Participants are r and omly assigned as dyads ( participant + coach pair ) to receiving either printed educational material s only ( PEM — control group ) or educational material s plus coach training ( COACH — intervention group ) . We defined a coach as family member , friend , or other lay support person design ated by the older adult . The coach training is design ed as a one-time , 35- to 40-minute training consisting of : 1 ) a didactic session that covers the role of the coach , basic facts about colorectal , breast and cervical cancers ( including risk factors , signs and symptoms and screening modalities ) , engaging the healthcare provider in cancer screening , insurance coverage for screening , and related healthcare issues , 2 ) three video skits addressing misconceptions about and planning for cancer screening , and 3 ) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened . The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings ( for breast , cervix or colorectal cancer ) between the control and intervention groups . Discussion Building on trusted patient contacts to encourage cancer screening , COACH is a highly sustainable intervention in a high-risk population . It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants ’ existing support networks . If effective , the intervention could have a high impact on health care disparities research across multiple diseases . Trial registration Clinical Trials.gov ( NCT01613430 ) . Registered June 5 , Background Delirium is a serious and common postoperative complication , especially in frail elderly patients . The aim of this study was to evaluate the effect of a geriatric liaison intervention in comparison with st and ard care on the incidence of postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour . Methods Patients over 65 years of age who were undergoing elective surgery for a solid tumour were recruited to a multicentre , prospect i ve , r and omized , controlled trial . The patients were r and omized to st and ard treatment versus a geriatric liaison intervention . The intervention consisted of a preoperative geriatric consultation , an individual treatment plan targeted at risk factors for delirium , daily visits by a geriatric nurse during the hospital stay and advice on managing any problems encountered . The primary outcome was the incidence of postoperative delirium . The secondary outcome measures were the severity of delirium , length of hospital stay , complications , mortality , care dependency , quality of life , return to an independent preoperative living situation and additional care at home . Results In total , the data of 260 patients were analysed .  Delirium occurred in 31 patients ( 11.9 % ) , and there was no significant difference between the incidence of delirium in the intervention group and the usual-care group ( 9.4 % vs. 14.3 % , OR : 0.63 , 95 % CI : 0.29–1.35 ) . Conclusions Within this study , a geriatric liaison intervention based on frailty for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour has not proven to be effective . Trial Registration Nederl and s Trial Register Trial ID NTR Objective We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy  , versus usual care , on one-year mortality . Method We conducted a multicentre , open-label interventional , stratified ( centre ) , parallel r and omised controlled trial , with a 1∶1 ratio , with two-year follow-up . Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition ( MNA , Mini Nutritional Assessment 17–23.5 ) . Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d , by face-to-face discussion targeting the main nutritional symptoms , compared to usual care . Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months . The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality , toxicities and chemotherapy outcomes . Results Between April 2007 and March 2010 we r and omised 341 patients and 336 were analysed : mean ( st and ard deviation ) age of 78.0 y ( 4·9 ) , 51.2 % male , mean MNA 20.2 ( 2.1 ) . Distribution of cancer types was similar in the two groups ; the most frequent were colon ( 22.4 % ) , lymphoma ( 14.9 % ) , lung ( 10.4 % ) , and pancreas ( 17.0 % ) . Both groups increased their dietary intake , but to a larger extent with intervention ( p<0.01 ) . At the second visit , the energy target was achieved in 57 ( 40.4 % ) patients and the protein target in 66 ( 46.8 % ) with the intervention compared respectively to 13 ( 13.5 % ) and 20 ( 20.8 % ) in the controls . Death occurred during the first year in 143 patients ( 42.56 % ) , without difference according to the intervention ( p = 0.79 ) . No difference in nutritional status changes was found . Response to chemotherapy was also similar between the groups . Conclusion Early dietary counselling  was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes . Cancer cachexia antianabolism may explain this lack of effect . Trial Registration Clinical Trials.gov OBJECTIVES To evaluate the effect of nurse case management on the treatment of older women with breast cancer . DESIGN R and omized prospect i ve trial . SETTING Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas . PARTICIPANTS Three hundred thirty-five women ( 166 control and 169 intervention ) aged 65 and older newly diagnosed with breast cancer . INTERVENTION Women seeing surgeons r and omized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer . MEASUREMENTS The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis . Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis . RESULTS More women in the intervention group received  breast-conserving surgery  ( 28.6 % vs 18.7 % ; P=.031 ) and  radiation therapy  ( 36.0 % vs 19.0 % ; P=.003 ) . Of women undergoing breast-conserving surgery , greater percentages in the case management group received  adjuvant radiation  ( 78.3 % vs 44.8 % ; P=.001 ) and axillary dissection ( 71.4 % vs 44.8 % ; P=.057 ) . Women in the case management group were also more likely to receive more breast reconstruction surgery ( 9.3 % vs 2.6 % , P=.054 ) , and women in the case management group with advanced cancer were more likely to receive chemotherapy ( 72.7 % vs 30.0 % , P=.057 ) . Two months after surgery , higher percentages of women in the case manager group had normal arm function ( 93 % vs 84 % ; P=.037 ) and were more likely to state that they had a real choice in their treatment ( 8 
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Interventions focused on discrete groups of older people with specific needs offering guidance or psychological support were more effective than those broadly targeting survival outcomes .
Advanced Practice Nursing roles , voluntary support roles and the involvement of geriatric teams provided some evidence of effectiveness .
Conclusions An array of workforce interventions focus on improving outcomes for older people with cancer but these are diverse and thinly spread across the cancer journey .
Higher quality and larger scale research that focuses on workforce features is now needed to guide developments in this field , and review findings indicate that interventions targeted at specific subgroups of older people with complex needs , and that involve input from advanced practice nurses , geriatric teams and trained volunteers appear most promising