Evidence-Based Minireview: Longitudinal geriatric assessment in quality care for older patients with hematologic malignancies

Lin, Richard J.; Klepin, Heidi D.

doi:10.1182/hematology.2019000076

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…Longitudinal geriatric assessments offer an opportunity to assess the impact of disease and treatment on health status during the course of AML survivorship [32]. Frailty is a dynamic state with patients both acquiring new vulnerabilities and demonstrating resilience and improvements in health status after initial AML therapy.…”

Section: Serial Geriatric Assessmentmentioning

confidence: 99%

Geriatric Assessment in Acute Myeloid Leukemia

Woods,

Klepin

2023

Acta Haematol

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Background Acute myeloid leukemia (AML) is a heterogenous disease that affects mostly older adults with varying baseline health and functional status. Treatment options have expanded for older adults ranging from less intensive chronic therapies to intensive induction strategies with curative intent. Despite this, outcomes remain poor with advancing age due to underlying disease biology and variability in treatment tolerance. Reliance on chronologic age alone, however, increases risks of both over- and under-treatment. Strategies to better characterize fitness in the context of therapy are needed to optimize decision-making and enhance clinical trial design. Summary Geriatric assessment (GA) is a series of validated tools that evaluate multiple health and functional domains of an older adult including physical function, comorbidities, cognition, nutrition, psychological health, and social support. While studies of GA in AML remain limited, current evidence shows that it is feasible to perform GA among older adults starting therapy for AML. GA measures including those assessing physical function, cognition, and mood are associated with mortality and toxicity in both the intensive and less intensive treatment settings. Key Messages In this review, we discuss the existing evidence to support use of GA in AML and highlight implications for clinical practice and future research.

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Section: Serial Geriatric Assessmentmentioning

confidence: 99%

Geriatric Assessment in Acute Myeloid Leukemia

Woods,

Klepin

2023

Acta Haematol

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“…Unfortunately, the availability of geriatric assessment is limited by the time and personnel required to complete it 1,8,9 . Recent evidence suggests that concise measures of physical function may predict treatment effects and survival in older adults as well as resource‐intensive comprehensive assessment 9‐13 …”

Section: Introductionmentioning

confidence: 99%

Gait speed, survival, and recommended treatment intensity in older adults with blood cancer requiring treatment

Hantel

DuMontier

Odejide

et al. 2020

Cancer

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Background Brief measures of physical function such as gait speed may be useful to optimize treatment intensity for older adults who have blood cancer; however, little is known about whether such assessments are already captured within oncologists' “gestalt” assessments. Methods Gait speed was assessed in 782 patients ≥75 years of age who had blood cancer, with results reported to providers after treatment decisions were made; 408 patients required treatment when different intensities were available per National Comprehensive Cancer Network (NCCN) guidelines. We performed structured abstractions of treatment intensity recommendations into standard intensity, reduced intensity, or supportive care, based on NCCN guidelines. We modeled gait speed and survival using Cox regression and performed ordinal logistic regression to assess predictors of NCCN‐based categorizations of oncologists' treatment intensity recommendations, including gait speed. Results The median survival by gait speed category was 10.8 months (<0.4 m/s), 18.6 months (0.4‐0.6 m/s), 34.0 months (0.6‐0.8 m/s), and unreached (>0.8 m/s). Univariable hazard ratios (HRs) for death increased for each lower category compared with ≥0.8 m/s (0.6‐0.8 m/s: HR, 1.76; 0.4‐0.6 m/s: HR, 2.30; <0.4 m/s: HR, 3.31). Gait speed predicted survival in multivariable Cox regression (all P < .05). In multivariable models including age, sex, and Eastern Cooperative Oncology Group performance status, gait speed did not predict oncologists' recommended treatment intensity (all P > .05) and did not add to a base model predicting recommended treatment intensity. Conclusion In older adults with blood cancer who presented for treatment, gait speed predicted survival but not treatment intensity recommendation. Incorporating gait speed into decision making may improve optimal treatment selection.

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“…However, all of these tools historically have only been applied at pre-therapy baseline. A longitudinal geriatric assessment could provide additional value in oncology, as domains tested in these assessments may dynamically change over time, as a result of competing factors of disease and remission status, chemotherapy toxicity and the development of new comorbidities unrelated to myeloma [9]. The longitudinal assessment of frailty as it changes over time in adults with MM undergoing treatment is largely unexplored.…”

Section: Introductionmentioning

confidence: 99%