Page 29 - Haematologica - Vol. 105 n. 6 - June 2020

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Buckstein49 2016 65+ Deschler50 2018
Derman51 2019
Dubruille52 2015
Dumontier53 2019 Hamaker54 2016 Huang55 2020
Lin56 2020 Liu57 2019 Muffly58 2014 Nawas59 2019
Rodrigues60 2020
Rollot-Trad61 2008
Silay62 2015
Velghe63 2014 70+
Various
445 71 (65-79)
CT 3
+ +
60+ Various 106 66 (60-78) HSCT 60+ Various 192 >67 (60-83) HSCT
65+ Various 90 74 (65-89) CT 75+ Various 464 80 (76-84) BSC; CT
65+ Various 157 78 (67-99) Various
50+ Various
60+ Various 75+ Various
148 62 (50-76)
457 66 (60-79) 448 80 (76-84)
HSCT
HSCT BSC; CT
50+ Various 203 58 (54-63) HSCT
50+ Various 184 61 (50-75) HSCT
60+ Various 40 68 (60-76) HSCT
75+, geriatric Various 54 86 (75-99) Various
department
65+ Various 61 69 ?
Various
50 76 (70-87)
Various 6 + +
Geriatric assessment in older patients with a hematologic malignancy
8+ 3
7+
6
5 2+
3+
5
6+
4
7
++ +
++
+ + Health care utilization
++
+ + Health care utilization,
toxicity ++
+ + Health care utilization
++
+ + Health care utilization,
toxicity
+
++
+ Health care utilization
*Reported as mean (± standard deviation) or median (range or interquartile range). GA: geriatric assessment; MDS: myelodysplastic syndrome; CT: chemotherapy; AML: acute myeloid leukemia; RAEB: refractory anemia with excess of blasts; FLT3: FMS like tyrosine kinase-3; BSC: best supportive care; HSCT: hematopoietic stem cell transplantation; CLL: chronic lymphocytic leukemia; DLBCL: diffuse large B-cell lymphoma; NHL: non-Hodgkin lymphoma; MM: multiple myeloma.
15 studies included various hematologic malignancies.49-63 The median number of domains addressed in the geri- atric assessment was four (range, 2-9). These included ADL in 30 studies (68%), IADL in 37 (84%), cognition in 29 (66%), mood in 24 (55%) and objectively measured physical capacity in 20 studies (46%). Domains less com- monly assessed were nutritional status (11 studies; 25%), social support (8 studies; 18%), polypharmacy (13 stud- ies; 30%) and frailty (8 studies assessed with a frailty screening tool and 17 studies by summarizing the geri-
atric assessment; 18% and 39%, respectively).
The prevalence of geriatric impairments was assessed in all studies (100%). The association between geriatric impairments and mortality was addressed in 33 studies (75%), treatment-related toxicity in ten studies (23%), treatment completion in five (11%) and healthcare uti- lization in seven studies (16%). No studies assessed the association of geriatric impairments with physical func-
tioning or quality of life after treatment.
Quality assessment
The results of the quality assessment are shown in Figure 1. Detailed results per study are listed in Online Supplementary Table S1. The overall quality of the studies was good. Nine studies included a significant proportion of younger patients (i.e. median age less than 68 years old, or more than one third of the patients younger than 65 years old);22,27,41,43,46,48,50,58,59 these studies were assessed as not being fully representative of the target cohort of the average older patients with a hematologic malignancy. Similarly, eight studies focused on a very specific treat- ment20,23,24,31,51,55,56,60 which we considered as not fully repre- sentative of our target population. Overall, the duration of follow-up was sufficient but in nine studies the follow- up rate was less than 90%24,30,46 or the adequacy of follow- up was not reported.27,32,33,56,57,62 There were no other qual- ity concerns.
Prevalence of geriatric impairments
The prevalence of geriatric impairments is shown in Table 2. The most commonly reported issues were polypharmacy (in a median of 51% of patients; range, 17- 80%), risk of malnutrition (median 44%; range, 27-82%) and IADL impairments (median 37%; range, 3-85%). Impaired physical capacity (median 27%; range, 3-80%), ADL impairments (median 18%; range, 4-67%), symptoms of depression (median 25%; range, 10-94%), and cognitive impairment (median 17%; range, 0-44%) were less com- mon. Four studies that addressed social support showed impairment in a median of 20% (range, 7-54%). The medi- an proportion of patients seen as frail based on a frailty screening tool was 68% (range, 25-76%). The median pro- portion of patients screened as frail based on a summarized geriatric assessment score was 45% (range, 10-88%).
Overall, the median proportion of patients with at least one geriatric impairment was 51% (range, 9-82%). By com- parison, the median proportion of patients with a World Health Organization (WHO) performance status of 2 or higher was only 29% (range, 1-91%). Even in studies in which the median age of patients was ≤65 years old, or a small proportion of patients had a poor WHO performance status, geriatric impairments were quite common. For example, in one study, 93% of included patients had a WHO performance status of 0-1; nonetheless, 45% of patients had impairments in IADL, 39% in physical capac- ity and 25% were frail based on a frailty screening tool (Table 2).49
Association between geriatric impairments and mortality
The association of geriatric impairments with mortality was addressed in 33 studies (Table 3). In univariate analy- sis, 27 out of 29 studies (93%) showed a significant asso- ciation between at least one geriatric impairment and mortality. The association between a specific geriatric domain and mortality varied between 0 and 74%.
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