Page 26 - Haematologica - Vol. 105 n. 6 - June 2020

Ferrata Storti Foundation
Haematologica 2020 Volume 105(6):1484-1493
Geriatric assessment in older patients with a hematologic malignancy: a systematic review
Ellen R.M. Scheepers,1 Ariel M. Vondeling,2 Noortje Thielen,1 René van der Griend,1 Reinhard Stauder3 and Marije E. Hamaker2
1Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands; 2Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands and 3Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
ABSTRACT
The aim of this systematic review is to give an update of all currently available evidence on the relevance of a geriatric assessment in the treatment of older patients with hematologic malignancies. A sys- tematic search in MEDLINE and EMBASE was performed to find studies in which a geriatric assessment was used to detect impaired geriatric domains or to address the association between geriatric assessment and survival or clinical outcome measures. The literature search included 4,629 reports, of which 54 publications from 44 studies were included. Seventy-three percent of the studies were published in the last 5 years. The median age of the patients was 73 years (range, 58-86) and 71% had a good World Health Organization (WHO) performance status. The median prevalence of geriatric impairments varied between 17% and 68%, even in patients with a good WHO performance status. Polypharmacy, nutritional status and instrumental activities of daily living were most frequently impaired. Whereas several geriatric impairments and frailty (based on a frailty screening tool or summarized geriatric assessment score) were predictive for a shorter overall survival, WHO per- formance status lost its predictive value in most studies. The association between geriatric impairments and treatment-related toxicity varied, with a trend towards a higher risk of (non-)hematologic toxicity in frail patients. During the follow-up, frailty seemed to be associated with treat- ment non-completion, especially when patients were malnourished. Patients with a good physical capacity had a shorter stay in hospital and a lower rate of hospitalization. Geriatric assessment, even in patients with a good performance status, can detect impaired geriatric domains and these impairments may be predictive of mortality. Moreover, geriatric impairments suggest a higher risk of treatment-related toxicity, treatment non-completion and use of healthcare services. A geriatric assessment should be considered before starting treatment in older patients with hematologic malignancies.
Introduction
Given the increasing life expectancy and aging of the population, there is a grow- ing number of older patients with cancer, including patients with a hematologic malignancy. Worldwide, hematologic malignancies account for approximately 9% of all cancers and are the fourth most frequently diagnosed cancer.1 At present, 60% of these patients are older than 65 years and this proportion will increase in the future.2,3
Over the last decades, treatment options for hematologic malignancies have pro- gressed. For example, the initial treatment of patients with multiple myeloma changed from cytotoxic chemotherapeutics to better-tolerated agents such as immuno-modulatory drugs or monoclonal antibodies.4 Moreover, the proportion of older patients with myelodysplastic syndrome or acute myeloid leukemia undergo- ing hematopoietic stem cell transplantation has increased, partly due to expansion of age limits.5,6
Correspondence:
ELLEN.R.M. SCHEEPERS
escheepers@diakhuis.nl
Received: December 24, 2019. Accepted: April 2, 2020. Pre-published: May 7, 2020.
doi:10.3324/haematol.2019.245803
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/6/1484
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