Association between Geriatric Impairments and Quality of Life in Older Adults with Lymphoma on Oral Targeted Therapies: A One‐Year Prospective Study

Abstract

Background: While oral targeted therapies (OTT) have transformed the care of patients (pts) with lymphoma, adherence, cost, and chronic low-grade toxicities with subsequent impact on health-related quality of life (HRQoL) remain challenging issues. There are limited data on HRQoL in older adults (OA), who tend to be more vulnerable to treatment-related adverse effects. We prospectively evaluated the role of geriatric assessment (GA) in predicting HRQoL and adherence in OA with lymphoma on OTT. Methods: Pts ≥70 years (yrs) with lymphoma, initiating or already on OTT were included. A GA was performed at baseline; pt, disease, and OTT characteristics were recorded. Pts were followed monthly for the first 3 months (mos), then every 3 mos for 1 year. QoL was measured at each visit using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 (EORTC QLQ-C30) and EORTC QLQ- chronic lymphocytic leukemia 16 (EORTC QLQ-CLL16) modules. The log QoL scores were modeled as a function of visit and mean scores at 12 months were compared to baseline using a linear mixed model. Results: We enrolled 50 pts. Median age was 77 yrs (70–93 yrs) with 88% pts having at least 1 geriatric syndrome (GS), including cognitive impairment (22%), depression (24%), polypharmacy (86%) and falls (16%); 50% pts had ≥2 GS; 50% having an impaired 4-meter gait speed (<1 m/s); 46% having an abnormal timed-up-and-go (TUG) time (>10s) and 86% had an adjusted CIRS-G score of ≥6. OTT included ibrutinib (54%), venetoclax (26%) and acalabrutinib (12%). At baseline, advancing age, activities of daily living (ADL) dependence, and instrumental activities of daily living (IADL) dependence were associated with inferior global health status, physical functioning, role functioning, and cognitive functioning scores. IADL dependence was also associated with worse social functioning and most symptoms scores. An abnormal TUG was associated with lower global health score (p = 0.002) and cognitive functioning (p = 0.003). At the end of 1 year, there was a statistically significant worsening of global health status (mean difference -8.4, p = 0.003) without any changes in other functional scales; however, it did not reach the predefined criterion for clinical relevance (absolute difference of >10, Figure 1). Only impaired baseline TUG was associated with significant worsening of global health status (-1.9 vs. -23.2, p = 0.048), physical (4.1 vs. -8.2, p = 0.031), role (1.3 vs. -18.5, p = 0.026) and social functioning (5.1 vs. -24.1, p = 0.016), and increasing fatigue scale (-11.5 vs. 20.4, p < 0.001) over 1 year. Other geriatric impairments did not impact changes in HRQoL over time. The research was funded by: Roswell Park Alliance Foundation Keywords: Cancer Health Disparities, Molecular Targeted Therapies Conflicts of interests pertinent to the abstract. P. Torka Consultant or advisory role: Genenetech, GenMab, Lilly USA, Seagen