Assessing frailty using comprehensive geriatric assessment in older patients with hematologic malignancy

Abstract

The incidence of hematologic malignancy increases with age; thus, the number of older patients who require intensive chemotherapy is expected to increase with the aging population. In Korea, 61.8%, 59.3%, 47.0%, and 46.7% of newly diagnosed cases of multiple myeloma, myelodysplastic syndrome, myeloproliferative disorder, and non-Hodgkin lymphoma, respectively, occurred in patients aged >65 years in 2018. Health status among older patients, defined by frailty, age-related syndrome of physiological decline and increased vulnerability, is associated with adverse health outcomes. Health status is highly heterogeneous among older patients, and treatment outcomes vary according to frailty and physiologic age rather than chronologic age. Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic and treatment process that identifies multiple domains, including functional status, cognition, comorbidities, medications, socioeconomic status, and nutritional status, to develop a coordinated plan to improve treatment-related outcomes and quality of life. Frailty can be assessed with CGA findings, and CGA is considered the “gold standard of care” for frail, older patients. Through CGA, unidentified problems can be assessed, and pre-emptive and non-oncologic interventions can be delivered. CGA is an objective and reliable tool for predicting further treatment-related complications and identifying patients for whom intensive chemotherapy with curative intent is appropriate. CGA should be considered a routine practice before starting treatment planning in older patients diagnosed with hematologic malignancies who require intensive chemotherapy. Further study is needed to allocate individualized treatment plans or multidisciplinary geriatric interventions according to CGA results.

The Five “Ws” of Frailty Assessment and Chronic Lymphocytic Leukemia: Who, What, Where, Why, and When

“…This assessment allows us to discern specific details and even provides a clear snapshot of the patient's movements in the video. Despite the barriers to implementing GA in clinical practice, particularly when there is limited time to evaluate a patient, the mounting clinical evidence strongly supports its effectiveness in patients with hematological malignancies [4,[59][60][61][62][63][64][65][66].…”

Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study

“…Although age-related functional decline and comorbidities are highly heterogeneous and associated with treatment outcomes in DLBCL [2][3][4][5][6][7][8], they are usually under-recognized in clinical practice. Comprehensive geriatric assessment is used in older patients with cancer to evaluate physical functioning, psychological health, level of comorbidities, and social well-being and can detect frail individuals who are not usually captured in routine assessment [9][10][11]. However, comprehensive geriatric assessment is not widely accepted for patients with DLBCL because it is time-consuming and has not been validated as a treatment guide.…”