Geriatric assessment in older patients with a hematologic malignancy: a systematic review

Frailty assessment in the care of older people with haematological malignancies

“…To date, there have been two systematic reviews in which the evidence on geriatric assessment in haematological malignancies was summarised on the basis of 15 and 44 geriatric assessment studies, respectively. 13,14 According to these data, vulnerability, as assessed by geriatric assessment and surrogated by geriatric impairments, was observed in most studies and in a substantial number of patients. For example, prevalence was 51% (range 17-80) for polypharmacy, 37% (3-85) for impaired instrumental and 18% (4-67) for impaired basic activities of daily living, 27% (3-80) for impaired physical capacity, 44% for malnutrition, 17% (0-44) for cognitive impairment, 25% for emotional impairment, and 20% for social support issues (ie, social frailty).…”

“…For example, prevalence was 51% (range 17-80) for polypharmacy, 37% (3-85) for impaired instrumental and 18% (4-67) for impaired basic activities of daily living, 27% (3-80) for impaired physical capacity, 44% for malnutrition, 17% (0-44) for cognitive impairment, 25% for emotional impairment, and 20% for social support issues (ie, social frailty). 13 In most studies, presence of geriatric impairments was predictive of shorter overall survival. Although observed in fewer studies, there were also associations between geriatric impairments and other adverse outcomes, such as treatment-related toxicity, treatment non-completion, and longer hospital stay.…”

“…There are several prognostically unfavourable outcomes that frailty can promote in the presence of a haematological malignancy, [11][12][13][14] including greater toxicity related to the haematological treatment, intercurrent illness unrelated to the haematological treatment, discontinuation of the haematological treatment, and earlier death either related or unrelated to the haematological cancer and its treatment. Estimating the individual likelihood of such events in an older patient using a thorough examination of frailty can be indicated for various reasons.…”

“…Moreover, in a systematic review among older people with haematological neoplasms for whom doctors attested a good performance status, numerous people were found to have factors associated with frailty, such as polypharmacy (ie, intake of at least five drugs) or impairments in cognition, emotion, nutrition, physical capacity, or activities of daily living. 13 To date, no large studies have investigated Fried frailty phenotype criteria or the Rockwood frailty index in people with haematological malignancies. Although these are considered gold standard techniques to capture frailty, these methods are difficult to implement in clinical practice and, therefore, are rarely used in routine care.…”

Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma

“… 25 , 26 Observational studies have demonstrated that GA predicts shorter survival, treatment discontinuation, and the risk of hospitalization beyond simple “performance status” assessments, mostly in the context of cytotoxic chemotherapy. 27 Clinical trials of chemotherapy-free approaches in indolent lymphomas have so far not used GA for patient selection. However, a recent Phase 2 study has demonstrated that patients age 65–80 who scored “fit” on the simplified comprehensive GA could be safely treated with a short course of immunochemotherapy (rituximab, bendamustine, plus mitoxantrone), achieving 78% rate of complete response (CR) and a 3-year PFS of 67%.…”