Abstract

Several societies have published recommendations for evaluating older adults with cancer in standard conditions. It is vital to assure a proper systematic patient condition evaluation, not only in the oldest (geriatric assessment) but in all adult patients. We have investigated the feasibility of a systematic evaluation of the general condition of all patients diagnosed with hematologic malignancies, and the degree of acceptance by the clinical team, in a prospective cohort of 182 consecutive adults, by using the ECOG performance status scale (ECOG, age 18 and over, 18+), Lee Index for Older Adults (LEE, 50+), Geriatric Assessment in Hematology (GAH, 65+), and the Comprehensive Geriatric Assessment (CGA, 75+). Clinical team acceptance was analyzed with a visual analogue scale, and the objective feasibility was calculated as the proportion of patients that could be finally evaluated with each tool. Acceptance was high, but the objective feasibility was progressively lower as the complexity of the different tools increased (ECOG 100%, LEE 99.4%, GAH 93.2%, and CGA 67.9%). LEE and GAH categories showed a weak concordance (Cohen’s Kappa 0.24) that was slight between LEE and CGA (Kappa 0.18). Unexpectedly, we found no significant association between the GAH and CGA categories (p = 0.16). We confirm that a systematic evaluation of all adult patients diagnosed with hematologic malignancies is feasible in daily practice by using an age-adapted approach. Direct comparisons among the different predictive tools in regard to patients’ tolerance to treatments of different intensities must be a priority research subject in the coming years.

Highlights

  • Patient condition (PC) evaluation has a key relevance for the treatment of patients diagnosed with malignancies

  • The aim of this study was to investigate the feasibility of a systematic and age-adapted evaluation of the PC of all patients diagnosed with hematologic malignancies (HMs) by means of dedicated clinical tools, as well as its acceptance by the clinical team

  • Patient distribution according to the different scales categories, as well as the reasons why 27 out of 84 patients aged 75 and over did not receive the comprehensive geriatric assessment (CGA) are shown in the Supplementary Materials (Tables S2–S6)

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Summary

Introduction

Patient condition (PC) evaluation has a key relevance for the treatment of patients diagnosed with malignancies. It is generally performed in a non-standardized manner by the attending physician, followed by the assignation of ECOG performance status (ECOG) and, ideally, a comprehensive geriatric assessment (CGA) in the oldest patients. Prior condition is a determinant of the expected survival and can be estimated by the Lee Index for Older Adults (LEE) [2] in those aged 50 and above (50+). This index can be calculated online at https://eprognosis.ucsf.edu/lee.php. It has been shown that LEE is an independent prognosticator of overall survival in myelodysplastic syndromes [3] and probably in chronic myelomonocytic leukemia and acute myeloid leukemia [4]

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