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

Hantel, Andrew; DuMontier, Clark; Odejide, Oreofe O.; Luskin, Marlise R.; Sperling, Adam S.; Hshieh, Tammy T.; Chen, Richard; Soiffer, Robert J.; Driver, Jane A.; Abel, Gregory A.

doi:10.1002/cncr.33344

Cited by 19 publications

(12 citation statements)

References 32 publications

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“…Evaluation of derived gait characteristics from the digital insole highlighted walking speed as an important determinant of knee OA classification, which is expected; 17 however, when derived gait characteristics highly correlated with speed were removed, the model still successfully detected knee OA subjects. Despite walking speed being clinically relevant [18][19][20][21] in studies of overall health status, it is unlikely to be able to distinguish between various musculoskeletal and neurological diseases and a speedindependent approach could enable more informative evaluation of gait disease signatures. This highlights that in addition to alterations in spatiotemporal parameters, there are additional features of gait in knee OA subjects that differentiate them from controls.…”

Section: Discussionmentioning

confidence: 99%

Machine learning analysis of a digital insole versus clinical standard gait assessments for digital endpoint development

Wipperman

Lin

Gayvert

et al. 2022

Preprint

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Biomechanical gait analysis informs clinical practice and research by linking characteristics of gait with neurological or musculoskeletal injury or disease. However, there are limitations to analyses conducted at gait labs as they require onerous construction of force plates into laboratories mimicking the lived environment, on-site patient assessments, as well as requiring specialist technicians to operate. Digital insoles may offer patient-centric solutions to these challenges. In this work, we demonstrate how a digital insole measuring osteoarthritis-specific gait signatures yields similar results to the clinical gait-lab standard. To achieve this, we constructed a machine learning model, trained on force plate data collected in participants with knee arthropathy and healthy controls. This model was highly predictive of force plate data from a validation set (area under the receiver operating characteristics curve (auROC) = 0.86; area under the precision-recall curve (auPR) = 0.90) and of a separate, independent digital insole dataset containing control and knee osteoarthritis subjects (auROC = 0.83; auPR = 0.86). After showing that digital insole derived gait characteristics are comparable to traditional gait measurements, we next show that a single stride of raw sensor time series data could be accurately assigned to each subject, highlighting that individuals (even healthy) using digital insoles can be identified by their gait characteristics. This work provides a framework for a promising alternative to traditional clinical gait analysis methods, adds to the growing body of knowledge regarding wearable technology analytical pipelines, and supports clinical development of at-home gait assessments, with the potential to improve the ease, frequency, and depth of patient monitoring.

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Section: Discussionmentioning

confidence: 99%

Machine learning analysis of a digital insole versus clinical standard gait assessments for digital endpoint development

Wipperman

Lin

Gayvert

et al. 2022

Preprint

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“…We undertook a cross-sectional analysis using data from the Older Adult Hematologic Malignancies (OHM) Program at Dana-Farber Cancer Institute (DFCI). 4,22,23,[30][31][32] All transplant-ineligible patients aged $75 years who presented for initial consultation in the leukemia, lymphoma, and myeloma clinics at DFCI between February 2015 and November 2019 were eligible. Those who consented to participate in the study underwent an in-person screening geriatric assessment administered by a research assistant on the same day as their initial hematologic oncology consultation.…”

Section: Study Design/populationmentioning

confidence: 99%

Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Hshieh

DuMontier

Jaung

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Polypharmacy and potentially inappropriate medications (PIMs) are common among older adults with blood cancers, but their association with frailty and how to manage them optimally remain unclear. Patients and Methods: From 2015 to 2019, patients aged ≥75 years presenting for initial oncology consult underwent screening geriatric assessment. Patients were determined to be robust, prefrail, or frail via deficit accumulation and phenotypic approaches. We quantified each patient’s total number of medications and PIMs using the Anticholinergic Risk Scale (ARS) and a scale we generated using the NCCN Medications of Concern called the Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale. We assessed cross-sectional associations of PIMs with frailty in multivariable regression models adjusting for age, gender, and comorbidity. Results: Of 785 patients assessed, 603 (77%) were taking ≥5 medications and 421 (54%) were taking ≥8 medications; 201 (25%) were taking at least 1 PIM based on the ARS and 343 (44%) at least 1 PIM based on the GO-PIM scale. Among the 468 (60%) patients on active cancer treatment, taking ≥8 medications was associated with frailty (adjusted odds ratio [aOR], 2.82; 95% CI, 1.92–4.17). With each additional medication, the odds of being prefrail or frail increased 8% (aOR, 1.08; 95% CI, 1.04–1.12). With each 1-point increase on the ARS, the odds of being prefrail or frail increased 19% (aOR, 1.19; 95% CI, 1.03–1.39); with each additional PIM based on the GO-PIM scale, the odds increased 65% (aOR, 1.65; 95% CI, 1.34–2.04). Conclusions: Polypharmacy and PIMs are prevalent among older patients with blood cancers; taking ≥8 medications is strongly associated with frailty. These data suggest careful medication reconciliation for this population may be helpful, and deprescribing when possible is high-yield, especially for PIMs on the GO-PIM scale.

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“…In a prospective observational study of patients with hematologic malignancies (29% various lymphomas), gait speed measured over a 4-meter walk strongly correlated with overall survival, unplanned hospitalizations, and emergency room visits—but did not appear to influence treatment intensity recommendation. 29 , 30 Although clinical data on indolent lymphomas are lacking, in the CLL9 clinical trial of cytotoxic chemotherapy, the TUG test was a better predictor of survival than the assessment of comorbidities and of the instrumental activities of daily living. 31 We recommend that clinicians formally assess their older patients with iBCL for functional capacity and that they consider chemotherapy-free regimens for frail individuals.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma

Ollila¹,

Olszewski²

2021

CMAR

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Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have <25% bone marrow involvement. The combination of rituximab and lenalidomide, although "chemotherapy-free", does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/ MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.

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

Cited by 19 publications

References 32 publications

Machine learning analysis of a digital insole versus clinical standard gait assessments for digital endpoint development

Machine learning analysis of a digital insole versus clinical standard gait assessments for digital endpoint development

Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma

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