Geriatric Assessment in Hematology Scale Classifies Frailty Phenotype
Researchers in Spain developed the Geriatric Assessment in Hematology (GAH) scale to classify patients as robust (those with strength or vigorous health) or frail (those with a poorer prognosis). The tool is validated for use in myelodysplastic syndromes, acute myeloid leukemia, multiple myeloma, and chronic lymphocytic leukemia. Researchers assessed its use and validity among patients with lymphoma. Raul Cordoba, MD, PhD, of Fundacion Jimenez Diaz University Hospital in Madrid, Spain, discussed the findings at the ASH Annual Meeting (https://ash.confex.com/ash/2018/webprogram/Paper116950.html) on December 3, 2018.
Researchers prospectively referred patients with hematologic malignancies who underwent a frailty screening test using the Geriatric 8 (G8) scale and had a score of less than 14 points to the geriatric oncology clinic between March 2016 and September 2017. Oncology nurses in the clinic assessed patients using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and GAH scales. A geriatrician also performed a comprehensive geriatric assessment.
Among the 96 referred patients, 55 were female (57.3%) and the median age was 79 years (range = 70–89 years). More than half of patients (n = 53; 55.2%) had lymphoma. Seventy-five patients (78.1%) had an Eastern Cooperative Oncology Group (ECOG) performance status score of 0–1. Most patients (n = 76; 79.2%) were classified as frail, according to the G8 scale. The CIRS-G score indicated that patients had a median of nine comorbidities (range = 4–20 comorbidities).
GAH assessment found that robust patients had a median of two affected domains (range = 1–4 domains), while frail patients had a median of four affected domains (range = 3–5 domains; p = 0.0001). Based on the area under the curve, the test had a sensitivity and specificity of 13.79% and 92.5%, respectively (p = 0.0003). For the GAH scale, 33 points was the cutoff value that identified robust versus frail patients, with a sensitivity and specificity of 77.5% and 62.07%, respectively (p = 0.0043).
According to a comprehensive geriatric assessment, compared with frail patients, robust patients had
- Reduced risk of polypharmacy (31.25% versus 81.48%; odds ratio [OR] = 0.1033; 95% confidence interval [CI] = 0.0472–0.2541; p < 0.0001)
- Lower gate speed or impairment (16.66% versus 81.48%; OR = 0.04545; 95% CI = 0.0183–0.1313; p < 0.0001)
- Decreased impairment in activities of daily living (37.5% versus 85.19%; OR = 0.1043; 95% CI = 0.0398–0.2684; p < 0.0001)
- Decreased mood impairment (4.17% versus 40.74%; OR = 0.06324; 95% CI = 0.01421–0.2498; p < 0.0001)
- Decreased mental health impairments (2.08% versus 22.22%; OR = 0.0744; 95% CI = 0.0068–0.4531; p = 0.0023)
- Fewer comorbidities (2.08% versus 42.59%; OR = 0.0286; 95% CI = 0.0027–0.1817; p < 0.0001)
- Less malnutrition (10.42% versus 37.04%; OR = 0.1977; 95% CI = 0.0759–0.5495; p = 0.0024)
- Better self-reported well-being (6.25% versus 66.67%; OR = 0.0333; 95% CI = 0.0101–0.1187; p < 0.0001).
The median overall survival for patients with three or fewer impaired domains was not reached, compared with 90.77 months in those with four to eight impaired domains (hazard ratio = 0.11; 95% CI = 0.04474–0.2846; p = 0.0003).
Robust patients had fewer comorbidities according to the CIRS-G scale (9 versus 11 points; p = 0.0001). In addition, the researchers observed correlations between CIRS-G and ECOG status with G8 score, as well as the brief comorbidity assessment in the GAH scale with CIRS-G score. Among patients without comorbidities, the median CIRS-G score was 9 versus 13.5 among patients with comorbidities, according the GAH scale (p < 0.0001).