Research News on Frailty in Blood Cancer Patients

Understanding frailty is crucial for patients as it is typically associated with negative outcomes. However, it is helpful for both patients and their healthcare team to consider whether or not they meet frailty criteria, as they can create strategies to improve the quality of life and reduce risks in frail patients. Research on frail patients can also be difficult, especially in some interventions where the exclusion criteria might cover some characteristics of frail patients. However, there is a need to continue exploring ways to improve the outcomes in this group.

In this article, you’ll learn the most important updates on personalizing treatment for those patients with AML considered frail. These were presented by blood cancer experts at the 66th ASH conference.  

What is Frailty? 

Frailty is a term that refers to certain symptoms that make a person more susceptible to experiencing adverse effects and incidents such as falls. The criteria is clinical and a medical professional can assess it with the clinical history and physical examination. To be considered frail, one must meet the following criteria: 

• Increased vulnerability resulting from aging-associated decline in multiple body systems and an affected ability to cope with everyday or acute challenges. 
• Low grip strength, low energy, slowed walking speed, low physical activity, and/or unintentional weight loss.

Frailty and Long-Term Survival Among Older Adults with Blood Cancers

The Older Adult Hematologic Malignancy (OHM) Program at Dana-Farber Cancer Institute conducted a study on 1271 older adults (median age 78) with blood cancer to evaluate three frailty assessment tools and how they relate to survival outcomes. All tools could reveal that there is a relationship between the dose of medication and frailty severity and survival. These findings highlight that assessing frailty in older adults before they receive cancer treatment can improve their care and outcomes.

Based on the assessment tools, 52% of the 1271 participants reported weak grip strength, 31% had an unintentional weight loss of ≥10 pounds in the past year, and 10% experienced exhaustion. 

All frailty assessment tools were able to identify patients whose frailty levels were associated with higher mortality.

Impact of Frailty Assessment on Hospital Stays in AML Patients

This population-based study of 5450 patients with AML analyzed how frailty impacts health resource utilization. The findings highlight that assessing frailty is essential for predicting healthcare resource utilization. Frailty was a stronger determinant than chemotherapy intensity or secondary AML, making it a crucial factor for tailoring AML treatment strategies. When addressed, it could potentially reduce healthcare resource utilization while improving patient outcomes.

• Patient Distribution by Fitness Status: 32.1% of patients didn’t meet frailty criteria, and 33.5% were evaluated as frail. Frailty was more prevalent in patients over 60 years old (42.2%). 
• Median overall survival: 12.5 months (non-frail had 17.6 months, while frail patients had 8.5 months).
• Healthcare Resource Utilization (HRU): Frail patients required longer hospital stays, 81% longer intensive care unit (ICU) stays, and 12% more frequent admissions. 
• Age Associations: Ages over 65 are correlated with higher intensive care unit admissions, longer hospital stays, and more hospital admissions.

The Impact of Frailty on Outcomes and Quality of Life in Allo-HCT

This multicenter study, conducted across 13 Spanish institutions, evaluated the feasibility and impact of using the HCT Frailty Scale in 403 adult patients. The study shows that frailty can change over time. Hence, it’s important to keep reassessing it to adjust treatment strategies and other supportive measures because there are different factors that can impact frailty such as treatment, symptoms, and time. Findings emphasize the importance of frailty assessment and tailored interventions to optimize allo-HCT outcomes.

Key Study Findings

• Frailty assessment integration: The HCT Frailty Scale assessment takes only 8-10 minutes, and when efficiently integrated into clinical practice, it can effectively identify frailty without additional resources. It is a vital tool that is easy to integrate and it provides crucial information to the care team. 
• Pre-habilitation benefits: Patients who underwent pre-habilitation had a significantly lower likelihood of frailty at admission for stem cell transplant.
• Stem cell transplant impact on frailty: The study showed that after 1 year of receiving a stem cell transplant, frailty was reduced by 6.4%.
• Frailty correlated with lower 1-year overall survival (OS) rates. 
• Risk factors: Some indicators, such as active disease, abnormal cognitive screening, and acute graft versus host disease, are considered to predict frailty.

Conclusions

The abstracts mentioned above shed light on the importance of frailty assessment in providing patients with better treatments, preventing longer hospitalizations, and improving overall survival. 

If you are a newly diagnosed blood cancer patient and want to know more about patient-centered care and comprehensive updates, we have more in-depth articles available here. 

Sources: 

• Frailty and Long-Term Survival Among Older Adults with Blood Cancers 
• FRAIL-HRU-AML: Impact of Frailty Assessment on Health Resource Utilization in Acute Myeloid Leukemia Patients: A Population-Based Study from Ontario, Canada
• The Impact of Frailty on Outcomes and Quality of Life in Allogeneic Hematopoietic Cell Transplantation: Summary of Results from a Collaborative Prospective Study Conducted on Behalf of the Geth-TC 
• Frailty assessment in adults undergoing allogeneic hematopoietic cell transplantation: insights from a multicenter GETH-TC study to optimize outcomes and care
• The Frailty Syndrome: Definition and Natural History