Study Highlights Need for Frailty Testing Among Older Adults with Blood Cancer

A slower walking pace among older adults with blood cancer can be a sign of frailty – which could be useful to know when tailoring one’s care to increase survival and lower hospitalizations.
BY Kristie L. Kahl
PUBLISHED August 05, 2019
A slower walking pace among older adults with blood cancer can be a sign of frailty, which in turn, may be linked to lower survival and an increased risk for hospitalization – which could be useful to know when tailoring one’s care, according to study findings published in Blood.

“The slower someone walks, the higher their risk of problems,” senior study author, Dr. Jane A. Driver, who is co-director of the Older Adult Hematologic Malignancy Program at Dana-Farber and associate director of the Geriatric Research Education and Clinical Center at VA Boston Healthcare System, said in a press release.

“There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes,” she added. “This test can be done in less than a minute and takes no longer than measuring blood pressure or other vital signs.”

Frailty

As life expectancy continues to rise, increasing age among the cancer population is an important risk factor to consider. With age also comes frailty, malnutrition and impaired physical function – which are increasingly prevalent among patients with blood cancers.

With that, frailty can lead to increased chemotherapy-related toxicity, poor response to therapy and mortality.

Even worse, although the majority of the cancer population are aged 65 and older, geriatric assessments are rarely conducted due to lack of time, experience or resources, the study authors wrote, adding that this highlights the need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes.

Walking Pace

The researchers aimed to determine the value of two brief functional tests (the Fried phenotype model and the Rockwood cumulative deficit index) in predicting important clinical outcomes among patients with various blood cancers.

In total, 448 patients aged 75 or older were broken into two groups: aggressive (diffuse large B cell lymphoma, mantle cell lymphoma, multiple myeloma, acute myeloid leukemia and acute lymphocytic leukemia) or indolent (marginal zone lymphoma, follicular lymphoma, chronic lymphocytic leukemia, monoclonal gammopathy of unknown significance, myelodysplastic syndrome, myeloproliferative neoplasm/myeloproliferative disease, Waldenstrom’s hypergammaglobulinemia, and hairy-cell leukemia).

A subset of 314 patients followed for at least 6 months at local institutions was evaluated for unplanned hospital or emergency department use.

The researchers found that slower walking speed was associated with higher mortality, odds of unplanned hospitalizations and emergency department visits; however, lower grip strength was associated with only lower survival.

“Based on our findings, (our screening test) is as good as other commonly used methods which take considerably more time and resources and may not be practical for many oncology clinics,” said Driver.

The researchers noted that their findings highlight the need for these tests to be integrated in patients’ routine clinical care – something individuals and the caregivers can ask physicians about moving forward.

“Our study reveals that the current standard of care for functional assessment in oncology—performance status—is not sufficient for elders with blood cancers,” explained Dr. Gregory A. Abel, director of the study clinic. “Gait speed appears to be much better at differentiating those patients at highest risk for poor outcomes.”
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