An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring

Starkman, Rebecca; Alibhai, Shabbir M.H.; Wells, Richard A.; Geddes, Michelle; Zhu, Nancy; Keating, Mary‐Margaret; Leber, Brian; Chodirker, Lisa; Sabloff, Mitchell; Christou, Grace; Leitch, Heather A.; St‐Hilaire, Ève; Finn, Nicholas; Shamy, April; Yee, Karen; Storring, John M.; Nevill, Thomas J.; Delage, Robert; Elemary, Mohamed; Banerji, Versha; Lenis, Martha; Kirubananthaan, Aksharh; Mamedov, Alexandre; Zhang, L.; Rockwood, Kenneth; Buckstein, Rena

doi:10.1038/s41375-019-0666-7

Cited by 23 publications

(13 citation statements)

References 30 publications

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“…Subsequently, an MDS-specific frailty index (FI) was developed that incorporated 42 deficits including comorbidities, laboratory values, physical performance instrumental activities of daily living (IADLs), quality of life, and performance status. 7 In addition to transfusion dependence, advanced age, and IPSS, the FI predicted survival on multivariable analyses, but the large number of measurements required for its calculation reduced its clinical utility. Consequently, a 15-item frailty scale (FS-15) derived from machine learning algorithms that kept the components with the highest impact within the FI retained its prediction of survival when added to the IPSS.…”

Section: Introductionmentioning

confidence: 99%

Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes

Mozessohn

Liu

et al. 2023

JCO Oncology Practice

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PURPOSE: The role of frailty in affecting survival in myelodysplastic syndromes (MDS) is increasingly recognized. Despite this, a paucity of data exists on the association between frailty and other clinically meaningful outcomes including health care resource utilization and costs of care. METHODS: We linked the Ontario subset of the prospective Canadian MDS registry (including baseline patient/disease characteristics) to population-based health system administrative databases. Baseline frailty was calculated from the 15-item MDS-specific frailty scale (FS-15). Primary outcomes were public health care utilization and 30-day standardized costs of care (2019 Canadian dollars) determined for each phase of disease (initial, continuation, and terminal phases). Negative binomial regression was used to assess the association between frailty and health care costs with Poisson regression to explore predictors of hospitalization. RESULTS: Among 461 patients with complete FS-15 scores, 374 (81.1%) had a hospitalization with a mean length of stay of 10.6 days. Controlling for age, comorbidities, Revised International Prognostic Scoring System, and transfusion dependence, the FS-15 was independently associated with hospitalization during the initial ( P = .02) and continuation ( P = .01) phases but not the terminal disease phase ( P = .09). The mean 30-day standardized cost per patient was $8,499 (median, $6,295; interquartile range, $2,798-$11,996), largely driven by cancer clinic visits and hospitalization. On multivariable analysis, the FS-15 was independently associated with costs of care during the initial disease phase ( P = .02). CONCLUSION: We demonstrate an association between frailty and clinically meaningful outcomes including hospitalization and costs of care in patients with MDS. Our results suggest that baseline frailty may help to inform patients and physicians of expected outcomes.

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Section: Introductionmentioning

confidence: 99%

Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes

Mozessohn

Liu

et al. 2023

JCO Oncology Practice

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“…17 In non-haematological cancers, fatigue, among several PROs, also independently improved accuracy of survival prognostication. 18 We previously demonstrated the contribution of fatigue to frailty 13 in a recently developed 42-item frailty index 19 and a modified 15-element frailty scale. 20 Both incorporate three fatigue thresholds of ≥7, 4-6 and 0-3 defined by the GFS, reinforcing the importance of this domain's contribution to the assessment of physiological reserve.…”

Section: Discussionmentioning

confidence: 99%

Patient‐reported fatigue refines prognosis in higher‐risk myelodysplastic syndromes (MDS): a MDS‐CAN study

Amitai

Geddes²,

Zhu

et al. 2021

Br J Haematol

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The incorporation of patient-reported outcomes with traditional disease risk classification was found to strengthen survival prediction in patients with myelodysplastic syndromes (MDS). In the present Canadian MDS registry analysis, we validate a recently reported prognostic model, the Fatigue-International Prognostic Scoring System among higher-risk patients [FA-IPSS(h)], which incorporates patients' reported fatigue, assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life-Core 30 (QLQ-C30), with a threshold of ≥45 points, in higher IPSS score, stratifying them into distinct subgroups with different survival outcomes. We further validated this concept, using the Revised IPSS >3Á5 as cut-off for the definition of higher-risk MDS, and patients' reported fatigue according to Edmonton Symptom Self-Assessment Scale (ESAS) Global Fatigue Scale (GFS), a single-item fatigue rating scale, which is easier to deploy. This emphasises the power of self-reported fatigue at refining overall survival predictions in higher-risk MDS and further bolsters the importance of considering patient-related outcomes in global assessments.

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“…Measurements of frailty are varied and can be tailored to a population of interest, as has been done in many disease states. 37 – 39 To date, there is no standardized definition of frailty in the literature. 40 Regardless of how frailty is measured, it signifies a vulnerability to age-related stressors.…”

Section: Frailtymentioning

confidence: 99%

Frailty in inflammatory bowel diseases: an emerging concept

Kochar

Orkaby

Ananthakrishnan

et al. 2021

Therap Adv Gastroenterol

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Inflammatory bowel diseases (IBD), consisting of Crohn’s disease and ulcerative colitis, are chronic remitting, relapsing inflammatory conditions of the gastrointestinal tract. While traditionally a disease of younger ages, the number of older adults with IBD is rising rapidly. Patients with IBD often experience geriatric syndromes at earlier ages. Older adults with IBD have poorer disease and treatment-related outcomes compared with younger adults with IBD. Applying the principles of geriatrics to understanding a chronic disease in older adults may improve health span. Better tools are needed to stratify IBD patients who are at high risk for adverse events. Frailty is a geriatric construct that may approximate biologic age. Frailty is a complex, multi-dimensional syndrome that leads to increased vulnerability to stress and decline of reserve across multiple physiologic systems. In this review, we present the leading conceptual models of frailty and discuss the applications of frailty in immune-mediated diseases. We also review chronic conditions where frailty has been applied successfully as a tool for risk stratification. Finally, we discuss in the detail the growing body of literature highlighting the relationship between frailty and IBD, the epidemiology of frailty in IBD, and ramifications of frailty in IBD.

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An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring

Cited by 23 publications

References 30 publications

Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes

Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes

Patient‐reported fatigue refines prognosis in higher‐risk myelodysplastic syndromes (MDS): a MDS‐CAN study

Frailty in inflammatory bowel diseases: an emerging concept

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