Frailty assessment to individualize treatment in older patients with lymphoma

• Published in: European geriatric medicine 2023-12, Vol.14 (6), p.1393-1402
• Main Authors: Hormigo-Sanchez, Ana I., Lopez-Garcia, Alberto, Mahillo-Fernandez, Ignacio, Askari, Elham, Morillo, Daniel, Perez-Saez, María A., Riesco, Miriam, Urrutia, Celia, Martinez-Peromingo, Francisco J., Cordoba, Raúl, Gonzalez-Montalvo, Juan I.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Comorbidity; Female; Frailty - diagnosis; Frailty - epidemiology; Geriatric Assessment - methods; Geriatrics/Gerontology; Humans; Internal Medicine; Lymphoma - therapy; Male; Medicine; Medicine & Public Health; Research Paper
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-023-00870-2

Key summary points Aim To study the application of a systematic protocol for specialized CGA in patients with lymphoma over 70 years of age. Findings Patients were classified by level of frailty, with different groups showing statistically significant differences in overall survival, response to treatment, and likelihood of increased frailty at the end of treatment. Message This study suggests that standardized, systematic CGA performed by geriatricians permits patient classification by level of frailty, helps in decision-making, and predicts clinical outcomes. Purpose A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment. Methods Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan–Meier survival curves. Results Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival ( p  = 0.002), response to treatment ( p