Abstract
The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00–1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41–4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60–9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10–6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21–1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05–1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11–4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07–3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.
Highlights
The median onset for hematologic malignancies is ~70 years of age [1]
The majority of patients referred to the Cancer and Aging Resiliency (CARE) clinic were reported to have Eastern Cooperative Oncology Group (ECOG) performance status of 0–1 (ECOG 0: n = 81, 34%; ECOG 1: n = 115, 49%) as identified by their primary hematologist within 30 days of geriatric assessment (GA)
Among 37 patients with case management needs identified, 16 (44%) were referred for financial counseling, 9 (24%) for home-community-based. In this real-world analysis of multidomain, consultative GA in older adults with hematologic malignancies (HMs), the accumulation of geriatric conditions correlated with the Rockwood Clinical Frailty Scale (CFS) rating
Summary
Advancing age is associated with inferior overall survival (OS) across all adult hematologic malignancies (HMs). This association between age and survival is complex and is impacted by comorbidities, geriatric syndromes, functional impairment, biological profiles, treatment decisions, and tolerance to therapy [2]. Increasing use of a geriatric assessment (GA) to quantify and qualify the physiological age provides valuable information about treatment tolerability and OS across multiple cancer types [3, 4]. For older adults with solid tumors, the use of a GA and optimization has led to less treatment-related toxicity [5, 6], improved quality of life, and lower healthcare resource utilization [7] in randomized controlled trials. Integrating GA with geriatric interventions for patients with HM is an unmet need
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