Frailty in Hematologic Malignancy

Abstract

Purpose of Review Older adults with hematologic malignancy are a growing demographic. Estimating risk of chemotherapy toxicity based on age alone, is an unreliable estimate of quality of life, functional capacity, or risk of treatment complications. Recent Findings Dedicated geriatric assessment tools can aid the clinician in identifying geriatric syndromes such as frailty, resulting in improved prognostication to decrease morbidity and mortality. Frailty is not synonymous with individual performance status and is dynamic. Summary Establishing the patient goals, values and preferences is central to the consideration of malignant hematology decision process. Careful considerations of available data on the patient’s prognosis based on estimated life expectancy, geriatric assessment data, and age-specific cancer mortality, with and without treatment, can reconcile the risks and benefits. Assessments of frailty, can aid the clinical feasibility and burden of the treatment to the patient and family in the context of each patient’s unique needs.

Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

“…[14][15][16] Although functional status is one component of frailty, additional measures such as weight loss and falls were not recorded reliably in our medical record. First, the population included mostly white, educated patients receiving their care at 2 tertiary care centers in Boston, and this limits the generalizability of our findings.…”

“…Frailty, in particular, has been shown to be an important predictor of outcomes for hematologic malignancies. [14][15][16] Although functional status is one component of frailty, additional measures such as weight loss and falls were not recorded reliably in our medical record. Fifth, limited data in our medical records also precluded retrospective calculations of ICU illness severity scores such as the Acute Physiology and Chronic Health Evaluation (APACHE) and the Sequential Organ Failure Assessment (SOFA).…”

“…[5][6][7][8][9][10] Two prior retrospective studies examined outcomes of younger patients with AML (median age, <55 years) receiving intensive chemotherapy who were admitted to the ICU. [11][12][13][14][15][16] Over the past 2 decades, the frequency of ICU admissions for patients with hematologic malignancies has increased. 6,7 However, data are lacking on the outcomes of older patients with AML (age ≥60 years) admitted to the ICU.…”

“…Because of the known associations of older age and frailty with higher ICU morbidity and mortality, it is particularly important to define the potential role of critical care for older patients with AML. [11][12][13][14][15][16] Over the past 2 decades, the frequency of ICU admissions for patients with hematologic malignancies has increased. 5,8,17,18 As these trends continue and larger numbers of patients are considered reasonable candidates for critical care, it is essential to identify which patients are most likely to benefit from intensive care interventions.…”

The pharmacologic management of multiple myeloma in older adults

“…The disparate use of various frailty tools and models make it difficult to apply uniform assessments of frailty in treatment and transplant decisions. Nonetheless, the myeloma community continues to explore how to best optimize treatment for older adults understanding that frailty is both quantifiable yet dynamic [30,31]. Clinicians still continue to rely upon clinical judgement and choose therapies they believe will provide maximum benefit while minimizing harm.…”