Novel functional assessment techniques for geriatric lymphoma patients

Abstract

8166 Background: Age over 60 and impaired “performance status” (PS) are adverse prognostic features in the International Prognostic Index (IPI) for lymphoma. However, patients over 60 comprise a heterogeneous population, and commonly used PS measures in oncology are subjective and incomplete. More discriminative tools may provide prognostic information that identify subgroups of older lymphoma patients with differing abilities to tolerate disease and treatment. Methods: Geriatricians have validated several tests which predict mortality and functional decline. We evaluated the performance of NHL outpatients aged 60 or older on 4 of these assessments. The timed “up and go” (UG) measures the time (seconds) needed to stand, walk 3 meters, and sit down. The “functional reach” (FR) measures the distance one can reach forward with a fixed base of support. The Tinetti scale (TGB) measures aspects of gait and balance. The hand grip (HG) measures grip strength with a hand-held meter. The primary objective of this pilot study is to establish the range of scores on these examinations in this patient population. Secondary objectives include correlation of scores with survival, treatment tolerance, and quality of life. Results: The mean age of subjects (N=25) was 70, 13 male (M) and 12 female (F). Five were newly-diagnosed, with 15 having aggressive, and 10 having indolent lymphoma. Twenty had an ECOG PS=1, 2 had PS=0, and 3 had PS=3. Within the largest (PS=1) group, the 4 tests each provided further discriminatory ability to differentiate among subjects. The IRQ/Median (higher values reflect greater variance) was 73.1 for HG, 42.3 for UG, 1.8 for TGB, and 16.8 for FR). M and F differed significantly in both the hand grip (M >F) and TGB (F>M). The HG and UG tests showed the most variability, even when stratified by sex. Conclusions: All of the tests demonstrated a range of scores within the ECOG PS=1 measure, and could be completed in about 5 minutes. Given the potential utility of these measures to discriminate among patients, we plan to prospectively study a larger cohort of older lymphoma patients to determine the ability of these assessments to predict survival, tolerability of therapy, and quality of life. No significant financial relationships to disclose.