Mechanisms of Benefit in Geriatric Assessment ( GA ): Approach‐Oriented Coping Mediates Outcomes of a GA ‐Guided Supportive Care Intervention ( GAIN ‐S)

BACKGROUND: Older adults with metastatic cancer often experience declines in physical function, emotional well-being, and quality of life (QOL). Geriatric assessment and management (GAM) have shown promise in addressing these challenges, but underlying mechanisms remain unclear. This study explored coping strategies as potential mediators for improvements in physical function, depression, and QOL. METHODS: For this secondary analysis of a randomized controlled trial, older adults (≥ 65 years) with metastatic cancer across multiple cancer centers in Brazil were recruited (n = 77). Participants were randomized 1:1 to receive either usual care (UC; n = 38) or a tailored multidisciplinary telehealth GAM intervention (GAIN-S; n = 39). Outcomes were assessed at baseline and 3 months, including Instrumental Activities of Daily Living (IADL), geriatric depressive symptoms (GDS), and Functional Assessment Cancer Therapy-General (FACT-G). Coping was assessed using the Brief COPE. Mediation analyses examined whether coping strategies explained intervention effects. RESULTS: Among 77 patients (mean age = 74 years; 56% female), most were married (61%), and well educated (50% ≥ college degree). The most common cancer types were genitourinary (29%), breast (24%), and gastrointestinal (22%) cancers. Mediation analyses revealed that improvements in approach-oriented coping mediated the effects of the GAM intervention on depressive symptoms (31%) and QOL (18%). Avoidant coping did not significantly mediate any outcomes. CONCLUSIONS: In the GAIN-S trial, improvements in approach-oriented coping partially mediated improvements in QOL and depressive symptoms outcomes among older adults with metastatic cancer. Enhancing adaptive coping could plays a key role in the care of older adults with cancer, and our results offer a novel mechanistic insight for GAM gains.