Page 30 - Haematologica - Vol. 105 n. 6 - June 2020

E.R.M. Scheepers et al.
Figure 1. Outcome of the quality assessment. Details are reported in Online Supplementary Table S1A (quality assessment questionnaire) and Online Supplementary Table S1B (assessment per study).
Polypharmacy was assessed in only two studies and showed no association. For all other geriatric domains except mood, nutritional status and social support, at least 50% of the studies reported a univariate association between impairment and mortality. IADL, ADL, impaired physical capacity and cognition were most frequently associated with mortality (in 74%, 67%, 63% and 55% of the studies, respectively). In multivariable analyses, ADL, IADL, impaired physical capacity and cognition remained associated with mortality (in 40%, 62%, 50% and 50% of the studies, respectively). Moreover, at least 75% of all studies that assessed frailty (with a frailty screening tool or by summarizing the geriatric assessment), demonstrated that this was associated with mortality in multivariable analyses.
Risk factors for mortality commonly used in hemato- oncology such as age, WHO performance status and comorbidity were also associated with mortality in uni- variate analysis (in 79%, 63% and 64% of the studies, respectively). However, in multivariable analyses, this association was no longer present for WHO performance status; age and comorbidity retained their association with mortality in 43% and 47% of the studies, respectively.
Association of geriatric impairments with treatment- related toxicity
Ten studies assessed geriatric impairments in relation to treatment-related toxicity.28,29,32-34,37,45,48,55,59 Four out of six studies in which frailty was assessed (based on a summa- rized geriatric assessment score) reported an association between frailty and treatment-related toxicity.33,34,45,48 This included hematologic toxicity in one study,33 non-hemato- logic toxicity in two studies45,48 and overall toxicity in one study.34 One study showed an association specifically between impaired IADL and treatment-related infections in patients with chronic lymphocytic leukemia.28 In stud- ies in which patients with various hematologic malignan- cies were included, associations between physical capaci- ty55 or cognition59 and treatment-related toxicity were demonstrated. No other associations between frailty
(based on a summarized geriatric assessment score) or individual geriatric domains and treatment-related toxicity were found in these ten studies.
Association of geriatric impairments with treatment completion
The association of geriatric impairments with the ability to complete the proposed treatment was studied in five studies.25,32,36,38,45 Four out of five studies found an associa- tion between geriatric impairments and treatment comple- tion. The risk of treatment non-completion was signifi- cantly higher in frail patients (based on a summarized geri- atric assessment score or frailty screening tool) than in fit patients.25,36,38,45 Three studies showed a significant associa- tion between a specifically geriatric domain and treatment non-completion: in two studies that included patients with non-Hodgkin lymphoma, malnutrition was associated with treatment non-completion.36,38 Another study, in which patients with acute myeloid leukemia or myelodys- plastic syndrome were included, showed an association between impaired IADL, impaired physical capacity or cognitive impairment and treatment non-completion. In this study, no other geriatric impairments or clinical char- acteristics such as comorbidity or WHO performance sta- tus were associated with treatment non-completion.25
Association of geriatric impairments with healthcare utilization
The association of geriatric impairments and health care utilization was addressed in seven studies.32,46,53,55,57,59,62 Six out of these studies showed an association between geriatric impairments and health care utilization. In four studies impaired physical capacity was associated with increased use of health care.46,55,57,62 In patients with various hemato- logic malignancies, other geriatric impairments, such as ADL,62 IADL,53 cognition59 and mood46 were also associated with health care utilization. In one study with patients with diffuse large B-cell lymphoma, no association was found between frailty (assessed by a summarized geriatric assess- ment score) and unplanned admissions.32
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