Enhancing Geriatric Assessment for Non-Hodgkin Lymphoma with Intrinsic Capacity: Can we move beyond existing models of Frailty?

Abstract

We read with interest the review by Akhtar et al. on “Geriatric assessment in older adults with non-Hodgkin lymphoma” [ [1] Akhtar O.S. Huang L.-W. Tsang M. Torka P. Loh K.P. Morrison V.A. et al. Geriatric assessment in older adults with non-Hodgkin lymphoma: a young International Society of Geriatric Oncology (YSIOG) review paper. J Geriatr Oncol. 2022; Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ], noting the emphasis and incorporation of geriatric assessment in selected clinically validated screening tools such as the Simplified Geriatric Assessment [ [2] Merli F. Luminari S. Tucci A. Arcari A. Rigacci L. Hawkes E. et al. Simplified geriatric assessment in older patients with diffuse large B-cell lymphoma: the prospective elderly project of the Fondazione Italiana Linfomi. J Clin Oncol. 2021; 39: 1214-1222 Crossref PubMed Scopus (36) Google Scholar ] and the Geriatric-8 Screening Tool [ [3] Bellera C.A. Rainfray M. Mathoulin-Pelissier S. Mertens C. Delva F. Fonck M. et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012; 23: 2166-2172 Abstract Full Text Full Text PDF PubMed Scopus (501) Google Scholar ]. These abbreviated geriatric assessment screening tools incorporate the assessment of functional impairment and the identification of frailty into clinical decision making and can predict treatment-related adverse events. While evaluating for frailty is key to the comprehensive geriatric assessment of older patients with non-Hodgkin lymphoma, using frailty as a lens through which these patients are viewed predominantly, may present an unbalanced perspective of their true functional reserve. In 2015, the World Health Organization, building on existing evidence for frailty, introduced the concept of intrinsic capacity as a novel model for capturing an individual's capacities and functions holistically as a multidimensional indicator of aging [ [4] World Health Organization WHO clinical consortium on healthy ageing topic focus: Frailty and intrinsic capacity. Geneva, Switzerland. 2017 Google Scholar ]. This represents a paradigm shift from Fried's phenotypic model of frailty [ [5] Fried L.P. Tangen C.M. Walston J. Newman A.B. Hirsch C. Gottdiener J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci. 2001; 56: M146-M157https://doi.org/10.1093/gerona/56.3.M146 Crossref PubMed Google Scholar ] or the cumulative-deficit model of frailty by Rockwood et al. [ [6] Rockwood K. Song X. MacKnight C. Bergman H. Hogan D.B. McDowell I. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173: 489-495https://doi.org/10.1503/cmaj.050051 Crossref PubMed Scopus (4166) Google Scholar ] toward a capacity-centred model [ [7] Araujo De Carvalho I. Martin C. Cesari M. Sumi Y. Thiyagarajan J.A. Beard J. Operationalising the concept of intrinsic capacity in clinical settings. Geneva, Switzerland. 2017 Google Scholar ]. Five key domains of intrinsic capacity include: cognition, mood, sensory, locomotion and vitality, with each domain influencing one another and interacting with environmental factors [ [8] Cesari M. Araujo De Carvalho I. Thiyagarajan J.A. Cooper C. Martin F.C. Reginster J.-Y. et al. Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci. 2018; 00: 1-8https://doi.org/10.1093/gerona/gly011 Crossref Scopus (212) Google Scholar ].