The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia.

Abstract

OBJECTIVES:

To test the feasibility and utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia (AML).

DESIGN:

Prospective observational cohort study.

SETTING:

Single academic institution.

PARTICIPANTS:

Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy.

MEASUREMENTS:

Bedside GA was performed during inpatient exmination for AML. GA measures included the modified Mini-Mental State Examination; Center for Epidemiologic Studies Depression Scale; Distress Thermometer, Pepper Assessment Tool for Disability (includes self- reported activities of daily living (ADLs), instrumental ADLs, and mobility questions); Short Physical Performance Battery (includes timed 4-m walk, chair stands, standing balance); grip strength, and Hematopoietic Cell Transplantation Comorbidity Index.

RESULTS:

Of 54 participants (mean age 70.8 ± 6.4) eligible for this analysis, 92.6% completed the entire GA battery (mean time 44.0 ± 14 minutes). The following impairments were detected: cognitive impairment, 31.5%; depression, 38.9%; distress, 53.7%; impairment in ADLs, 48.2%; impaired physical performance, 53.7%; and comorbidity, 46.3%. Most were impaired in one (92.6%) or more (63%) functional domains. For the 38 participants rated as having good performance status according to standard oncologic assessment (Eastern Cooperative Oncology Performance Scale score ≤1), impairments in individual GA measures ranged from 23.7% to 50%. Significant variability in cognitive, emotional, and physical status was detected even after stratification according to tumor biology (cytogenetic risk group classification).

CONCLUSION:

Inpatient GA was feasible and added new information to standard oncology assessment, which may be important for stratifying therapeutic risk in older adults with AML.

• Authors: Heidi D Klepin, Ann M Geiger, Janet A Tooze, Stephen B Kritchevsky, Jeff D Williamson, Leslie R Ellis, Denise Levitan, Timothy S Pardee, Scott Isom, Bayard L Powell
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 59 Issue 10 Pg. 1837-46 (Oct 2011) ISSN: 1532-5415 [Electronic] United States
• PMID: 22091497 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

Topics

• Aged
• Aged, 80 and over
• Cohort Studies
• Comorbidity
• Disability Evaluation
• Feasibility Studies
• Female
• Geriatric Assessment (methods)
• Hospitalization
• Humans
• Induction Chemotherapy
• Leukemia, Myeloid, Acute (drug therapy)
• Male
• North Carolina
• Nursing Assessment
• Prospective Studies