Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies

• Published in: Journal of the American Geriatrics Society (JAGS) 2019-05, Vol.67 (5), p.889-897
• Main Authors: DuMontier, Clark, Liu, Michael A., Murillo, Anays, Hshieh, Tammy, Javedan, Houman, Soiffer, Robert, Stone, Richard M., Driver, Jane A., Abel, Gregory A.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Blood cancer; Cancer; Cognitive ability; Disease Management; Female; Follow-Up Studies; function; geriatric assessment; Geriatric Assessment - methods; geriatric oncology; Geriatrics; hematologic malignancies; Hematologic Neoplasms - epidemiology; Hematologic Neoplasms - therapy; Humans; instrumental activities of daily living; Male; Massachusetts - epidemiology; Morbidity - trends; Mortality; Older people; Oncology; Patient Acceptance of Health Care - statistics & numerical data; Prospective Studies; Risk Assessment - methods; Survival; Survival Rate - trends
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.15835

BACKGROUND/OBJECTIVES Cancer‐focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute‐care utilization in populations of older adults with different hematologic malignancies. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS A screening geriatric assessment was conducted for adults 75 years and older with hematologic malignancies (n = 464) presenting for initial consultation at a large tertiary cancer hospital in Boston, MA. MEASUREMENTS Univariable and multivariable analyses assessed the association of dependency in ADLs and dependency in iADLs with survival and care utilization (emergency department [ED] visits and unplanned hospitalizations). RESULTS Subjects were a mean age of 79.7 years and had a mean follow‐up of 13.8 months. Overall, 11.4% had dependency in ADLs and 26.7% had dependency in iADLs. Only iADL dependency was associated with higher mortality (hazard ratio = 2.34 [95% confidence interval [CI] = 1.46‐3.74]) independently of age, comorbidity, cancer aggressiveness, and treatment intensity. The effect was dose dependent, and impairments in shopping, meal preparation, and housework were all independently associated with a higher hazard of death. iADL dependency was also associated with higher odds of ED visits (odds ratio [OR] = 2.76 [95% CI = 1.30‐5.84]) and hospitalizations (OR = 2.89 [95% CI = 1.37‐6.09]). Several geriatric domain impairments, including probable cognitive impairment and physical dysfunction, were associated with iADL dependency. CONCLUSION These findings suggest that older adults with hematologic malignancies and iADL dependency experience higher mortality and acute‐care utilization, arguing that iADLs should be formally assessed as part of routine oncology care. J Am Geriatr Soc 67:889–897, 2019.