Cargando…

Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies

The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describ...

Descripción completa

Detalles Bibliográficos
Autores principales: Wall, Sarah A., Huang, Ying, Keiter, Ashleigh, Funderburg, Allesia, Kloock, Colin, Yuhasz, Nicholas, Gure, Tanya R., Folefac, Edmund, Stevens, Erin, Presley, Carolyn J., Williams, Nicole O., Krok-Schoen, Jessica L., Naughton, Michelle J., Rosko, Ashley E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692664/
https://www.ncbi.nlm.nih.gov/pubmed/34956894
http://dx.doi.org/10.3389/fonc.2021.775050
_version_ 1784618983746437120
author Wall, Sarah A.
Huang, Ying
Keiter, Ashleigh
Funderburg, Allesia
Kloock, Colin
Yuhasz, Nicholas
Gure, Tanya R.
Folefac, Edmund
Stevens, Erin
Presley, Carolyn J.
Williams, Nicole O.
Krok-Schoen, Jessica L.
Naughton, Michelle J.
Rosko, Ashley E.
author_facet Wall, Sarah A.
Huang, Ying
Keiter, Ashleigh
Funderburg, Allesia
Kloock, Colin
Yuhasz, Nicholas
Gure, Tanya R.
Folefac, Edmund
Stevens, Erin
Presley, Carolyn J.
Williams, Nicole O.
Krok-Schoen, Jessica L.
Naughton, Michelle J.
Rosko, Ashley E.
author_sort Wall, Sarah A.
collection PubMed
description The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00–1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41–4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60–9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10–6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21–1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05–1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11–4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07–3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.
format Online
Article
Text
id pubmed-8692664
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-86926642021-12-23 Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies Wall, Sarah A. Huang, Ying Keiter, Ashleigh Funderburg, Allesia Kloock, Colin Yuhasz, Nicholas Gure, Tanya R. Folefac, Edmund Stevens, Erin Presley, Carolyn J. Williams, Nicole O. Krok-Schoen, Jessica L. Naughton, Michelle J. Rosko, Ashley E. Front Oncol Oncology The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00–1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41–4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60–9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10–6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21–1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05–1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11–4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07–3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs. Frontiers Media S.A. 2021-12-08 /pmc/articles/PMC8692664/ /pubmed/34956894 http://dx.doi.org/10.3389/fonc.2021.775050 Text en Copyright © 2021 Wall, Huang, Keiter, Funderburg, Kloock, Yuhasz, Gure, Folefac, Stevens, Presley, Williams, Krok-Schoen, Naughton and Rosko https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Wall, Sarah A.
Huang, Ying
Keiter, Ashleigh
Funderburg, Allesia
Kloock, Colin
Yuhasz, Nicholas
Gure, Tanya R.
Folefac, Edmund
Stevens, Erin
Presley, Carolyn J.
Williams, Nicole O.
Krok-Schoen, Jessica L.
Naughton, Michelle J.
Rosko, Ashley E.
Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies
title Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies
title_full Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies
title_fullStr Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies
title_full_unstemmed Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies
title_short Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies
title_sort integration of a geriatric assessment with intervention in the care of older adults with hematologic malignancies
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692664/
https://www.ncbi.nlm.nih.gov/pubmed/34956894
http://dx.doi.org/10.3389/fonc.2021.775050
work_keys_str_mv AT wallsaraha integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT huangying integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT keiterashleigh integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT funderburgallesia integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT kloockcolin integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT yuhasznicholas integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT guretanyar integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT folefacedmund integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT stevenserin integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT presleycarolynj integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT williamsnicoleo integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT krokschoenjessical integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT naughtonmichellej integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies
AT roskoashleye integrationofageriatricassessmentwithinterventioninthecareofolderadultswithhematologicmalignancies