What is personalized fitness-based care?

What is meant by the phrase personalized fitness based care? Personalized fitness based care really refers to the concept of treating every patient with myeloma and I should say this for patients with cancer in general based on their fitness status. And what this idea has come, arose from is really the, when you think about clinical trials historically patients who were older were excluded just based on age alone. But we know that patients who are 70 years old or 75 that that does not automatically translate into being frail. And some of those patients are very fit and very robust. And so when you take a 55 year old for instance who may have many medical conditions that may be frail whereas the 70 year old is fit. But if you use cutoffs of just chronologic age then patients are excluded from treatments. And so using a fitness based approach allows for providers to take a more comprehensive look at patients and think about all of the things that can affect their ability to tolerate their cancer therapies. And so that includes not only their age alone but thinking about their functional status, thinking about whether or not they have support in the home when you're thinking about your therapies, other things like their nutritional status. So all of these things come together when you want to think about a patient's overall fitness. And then we take those considerations which is all lumped together in what we would call the comprehensive geriatric assessment which is capable of giving a global assessment of an older adult's fitness level. And then we use that to inform how we would treat a patient with myeloma or with cancer. Why consider fitness in terms of treatment for patients? So this is really important because in patients who are considered frail, you could imagine that these are going to be the patients who are going to be at greatest risk for toxicities related to treatment. And these are also going to be the patients at risk for early discontinuation of their therapies. And there may be other factors that actually influence whether or not these patients are able to adhere to the prescribed treatment regimen such as, can I get to my appointments because I don't have transportation? Or I live alone, I'm falling all the time. That influences the type of drugs that you're able to give and how frequently you're able to deliver them to this patient. So when you think about an overall fitness for a patient, it really helps because it prevents both undertreatment and overtreatment of the older adult population. If you're fit but old, does that mean you're in the geriatric category? The answer to that is really no, because fitness, again, we're not looking at a certain cutoff of age to define whether or not a patient is fit. But we really think about other measures as mentioned that really make that decision about their fitness level. So as you mentioned, a younger patient who is not considered geriatric by the standard cutoff of age of 65 could also be less fit or frail depending on if they have other functional deficits or comorbidities. But then there could be an older patient who is considered geriatric in the sense of the term and then they may also be fit or they could either be frail. So I think the idea is that we are moving further and further away from thinking of geriatrics as a strict age cutoff, but more looking at what is happening with the patient and how fit or frail that patient is to really define who really benefits from the interventions from a geriatrician or other geriatrics focused specialists.