A PROSPECTIVE STUDY TO EVALUATE THE UTILITY OF GERIATRIC ASSESSMENT AND INTERVENTION IN PATIENTS WITH LYMPHOPROLIFERATIVE DISORDERS IN A TERTIARY HOSPITAL

Abstract

Introduction: Haematological malignancies are frequent in elderly and its management represent a challenge to be solved. The geriatric assessment (GA) is useful in elderly patients with cancer. However, there is little information regarding its usefulness in lymphoma patients. Our aim in this study is to evaluate the utility of GA in older patients with lymphoproliferative disorders. Patients and Methods: Since 05/2015, patients older than 70 y/o diagnosed with lymphoma in our centre were invited to participate in this study. Patients considered not eligible for treatment were excluded. All patients included were subjected to G8 screening and integral GA before the beginning of treatment. Five follicular lymphoma patients on “watch and wait” strategy were excluded for analysis. G8 screening tool with a cut off of 14 divided the patients into two groups: those considered fit (+14 pts) who wouldn't receive geriatric follow up, and patients considered unfit (−14 pts) who would receive geriatric follow-up and intervention if required. The trial was approved by local ethic committee. Geriatrics syndromes evaluated (at months 0, 4, 8, 12, and 18–24) were fragility, malnutrition, syncope, dizziness, urinary incontinence, gait abnormalities, falls, osteoporosis, dementia, behavioural disturbance, delirium, depression, sleep disturbance, pressure ulcers and chronic ache. Tests performed: Dukes scale (social support), Barthel and Lawton scales (activities of daily living), Charlson scale (comorbilities), MNA-SF (nutritional assesment), SPPB (funcionality), and FRIED sacale (fragility). Results: For this interim analysis, 36 patients were considered valid (treated patients). We identified 10 patients fit and 26 patients unfit. Patient's characteristics are included in table 1. Basal geriatric assessment is included in table 2. The median follow-up was 12 months. One year event free survival (EFS) was 73%, overall survival (OS) was 85%, and cumulative incidence of non-relapse mortality (NRM) was 15.5%. Geriatric intervention was required in 66.7% of patients. Two patients (8.7%) considered initially as fit, changed during follow-up to the unfit group. In 87% of cases, a new previously unknown disturbance was detected by geriatric intervention. Polypharmacy (three or more drugs) was identified in 65% of patients. In 82% of unfit cases, a new geriatric syndrome was detected (gait abnormalities, chronic ache, and urinary incontinence). Adjustment of treatment by geriatric intervention occurred in 75% of patients. Participation of the geriatricians in the decisions regarding chemotherapy treatment affected 8.3% of the cases. Conclusions: Geriatric intervention in patients with lymphoma changes the management of these patients and may influence their outcome. The future results of this study will help us to establish the benefits of adequate basal geriatric assessment and intervention. Keywords: elderly; immunochemotherapy; performance status.