Abdominal hysterectomy and high frailty score are associated with complications among older patients

2021 ◽  
Author(s):  
Julia J. Wainger ◽  
Golsa Yazdy ◽  
Victoria L. Handa
Keyword(s):  
Older Patients ◽  
Abdominal Hysterectomy ◽  
Frailty Score

scholarly journals 160 The Effect of Frailty and COVID-19 Infection on Clinical Outcomes in Older Adults—A Single Centre Retrospective Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
O Okuwoga ◽  
S Mufti
Keyword(s):  
Older Patients ◽  
Single Centre ◽  
Clinical Frailty Scale ◽  
Health Records ◽  
Frail Patients ◽  
Nice Guidance ◽  
Data Points ◽  
Continued Use ◽  
Support Decision Making ◽  
Frailty Score

Abstract Introduction It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital. Methods A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9). Results A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p < 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients. Conclusion The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.

Poor surgical outcomes in frail older patients with pancreatic cancer when using VMS as frailty score

2021 ◽  
Vol 12 (8) ◽  
pp. S55-S56
Author(s):  
R. Dekker ◽  
D. Souwer ◽  
A. Berzina ◽  
S. Luelmo ◽  
S. Mieog ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Outcomes ◽  
Older Patients ◽  
Frailty Score

COMPARISON OF FRAILTY SCORES IN NEWLY DIAGNOSED PATIENTS WITH MULTIPLE MYELOMA: A REVIEW

2019 ◽  
pp. 1-7 ◽  
Author(s):  
H. Mian ◽  
M. Brouwers ◽  
C.T. Kouroukis ◽  
T.M. Wildes
Keyword(s):  
Multiple Myeloma ◽  
Older Patients ◽  
Treatment Options ◽  
Clinical Settings ◽  
Newly Diagnosed ◽  
Future Directions ◽  
Malignant Plasma Cell ◽  
Co Morbidity ◽  
Morbidity Index ◽  
Frailty Score

Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The challenge in treating older patients is to accurately identify ‘fit’ patients that can tolerate more intensive treatment to maximize disease control, while simultaneously identifying vulnerable or ‘frail’ patients who may develop toxicity with significant morbidity and mortality, requiring different treatment options or dose modification. Multiple frailty scores have been devised for multiple myeloma over the years in newly-diagnosed patients. This paper gives an overview of the three common frailty measurements: the International Myeloma Working Group Frailty Score, Mayo Clinic Frailty Score and the Revised Myeloma Co-Morbidity Index. We will summarize the derivation, validation, usability and applicability of these scores in different clinical settings, emphasizing the main strengths and limitations for each index score. We will also highlight future directions in the operationalization of frailty in multiple myeloma.

Development of a Frailty Score for Older Patients with Myelodysplastic Syndromes and Acute Myeloid Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1775-1775
Author(s):  
Barbara Deschler ◽  
Gabriele Ihorst ◽  
Uwe Platzbecker ◽  
Ulrich Germing ◽  
Michael Lübbert
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Activities Of Daily Living ◽  
Cell Transplantation ◽  
Daily Living ◽  
Older Patients ◽  
Treatment Allocation ◽  
Frailty Score

Abstract Abstract 1775 Poster Board I-801 Introduction Treatment options in older patients (pts) with MDS/AML range from best supportive care (BSC) to intensive chemotherapy/hematopoietic stem cell transplantation (IC/HCT), with low-dose chemotherapy or novel non-intensive agents (e.g. hypomethylating agents; HA) as alternatives. Due to frequent age-related physical and/or mental impairments, intensive treatment is not always feasible. As the basis for treatment decision-making is not well defined, the generation of comprehensive assessments of age-specific functional and quality of life (QOL)-aspects in addition to disease-specific risk factor definition therefore is urgently needed. Geriatric Assessment (GA) is expected to offer rational support in this process. Patients and Methods Since January 2004, we have prospectively evaluated the prognostic impact of GA on overall survival (OS) in 195 consecutive pts ≥60 years (yrs) with AML (n=132) or MDS (n=63) in three participating centers, receiving either BSC or HA+BSC or IC/HCT. Of the pts receiving non-intensive treatment, 50% had MDS. GA included eight instruments evaluating QOL, activities of daily living, depression, mental functioning, mobility, comorbidities and performance status (PS). In addition, disease- and patient-specific laboratory parameters were obtained. Results Median age of pts was 71 yrs (range: 60-87 yrs). The primary treatment allocation was BSC in 47 pts (median age: 75 yrs); HA+BSC in 66 pts (74 yrs); IC/HCT in 75 pts (68 yrs). 62% of IC/HCT pts received a matched related/unrelated stem cell transplantation. Application of age-specific tests at the different study centers was readily feasible. The initial multidimensional GA was associated with treatment allocation, age, hematological and functional parameters and treatment outcome. Multivariate analyses revealed impairments in activities of daily living (ADL: Barthel Test, HR: 2.22) and fatigue (measured by EORTC QLQ-C30; HR: 1.68) as significant prognostic parameters for overall survival. Both risk factors were combined to construct a simple risk score for survival. Conducting a Cox regression model with established risk factors, a high risk frailty score in the entire pt population was associated with an elevated HR of 4.17 (p<0.0001), while adverse cytogenetics (AML), blasts >20% and comorbidities >1 proved to be independently associated with HRs of 2.491 (p=0.0001), 2.756 (p=0.0005) and 1.495 (p=0.1281). When this score was applied to pts receiving sole BSC or HA+BSC, highly significant differences in OS could be demonstrated, with p=0.0035 and p<0.0001, respectively. Conclusions Our data demonstrate that GA is a useful and objective tool in the in-depth evaluation process prior to treatment allocation in elderly patients with MDS/AML. A simple prognostic score based solely on ADL and fatigue to predict outcome of patients treated non-intensively has been established. Validation in independent cohorts appears warranted. Disclosures No relevant conflicts of interest to declare.

Prediction of Poor Outcome in Older Patients Receiving Chemotherapy for Malignant Lymphoma: A New Frailty Scoring

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2353-2353
Author(s):  
Stephanie Dubruille ◽  
Cindy Kenis ◽  
Yves Libert ◽  
Michel Delforge ◽  
Catherine Choffray ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Board Of Directors ◽  
Older Patients ◽  
Causes Of Death ◽  
Functional Decline ◽  
Advisory Committees ◽  
Frail Patients ◽  
Vulnerable Patients ◽  
To Receive ◽  
Frailty Score

Abstract Introduction: Patients "clinically fit" to receive chemotherapy suffering from malignant hemopathies, are an heterogeneous population covering fit and vulnerable patients. Patients with geriatric syndromes and/or irreversible comorbidities are usually excluded from high dose chemotherapy. However, a reliable "frailty score" remains urgently needed to better define the vulnerable population that does not benefit from chemotherapy. In the literature, two clinical (functional decline and Mild Cognitive Impairment (MCI)) and two biological (anemia and inflammation) factors are frequently correlated with poor overall survival (OS) or chemotherapy-related toxicity. Objective: To determine a clinico-biological tool for the screening of vulnerable patients with malignant hemopathies presenting unacceptable chemotherapy-related toxicity or disappointing result defined as a poor OS. Methods: This prospective multicentric study was conducted in the institute 'Jules Bordet' (Brussels) and in the University Hospitals of Leuven (Leuven). A Comprehensive Geriatric Assessment (CGA) was performed to 251 consecutive patients (65-90yrs) with malignant hemopathies admitted to receive chemotherapy. Clinical data, biological parameters and causes of death were extracted from medical records. A screening tool composed of 0 to 4 of the prognostic factors (loss of functional autonomy (Activities of Daily Living scale [ADL]), MCI (Mini Mental State Examination [MMSE]), anemia [hemoglobin] and inflammation [CRP]) was applied to our population. Univariate and multivariate Cox proportional hazards model were used to predict OS. Results: One hundred and eighty two patients were evaluable for all characteristics (NHL, n=105; CLL, n=20; MM, n=26; AML, n=17; ALL, n=6; LMMC, n=3, MDS, n=5). Eighty-three percent had a more favorable prognosis (NHL, CLL or MM) and fifty-five percent have a first diagnosis of cancer. A "frailty" scoring system (range 0-4) was developed, based on items we identified as predictive factors: functional decline (ADL<6, n=94), Mild Cognitive Impairment (MCI) (MMSE<27, n=51), anemia (HB<11g/dl, n=90) and inflammation (CRP≥2mg/l, n=149). The population was stratified into 3 groups: fit (score=0-1, n=56), vulnerable (score= 2, n=60) and "frail" (score= 3 or 4, n=66). The OS was 86% in fit, 60% in vulnerable (hazard ratio (HR)=3.29; 95% CI=1.48-7.33; P=.004) and 41% in "frail" patients (HR=5.87; 95% CI=2.74-12.59; P<.001). Causes of death remain disease-related in a majority of the patients (82%). In our largest group of older patients (NHL, n=105), the frailty scoring was also applied (ADL<6, n=48; MMSE<27, n=29; HB<11g/dl, n=36; CRP≥2mg/l, n=85): the OS was 87% in fit (n=45), 65% in vulnerable (n=31) (HR=2.94; 95% CI=1.11-7.96; P=.034) and 41% in "frail" patients (n=29) (HR=6.61; 95% CI=2.60-16.83; P<.001) and thus reliable in this specific population. Conclusions: In our selected population of patients with malignant hemopathies and particularly in the group of NHL, "clinically fit" to receive chemotherapy, our "frailty score" helps clinician to predict a poor OS. This scoring detects unsuspected "frail" patients who may benefit from palliative care. Further prospective analyses in a larger population, are on going to refine the score in other malignant hemopathies in order to avoid overtreatment in these vulnerable older patients. Disclosures Maerevoet: roche: Membership on an entity's Board of Directors or advisory committees; ARGN-X: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Functional Predictors of Chemotherapy Toxicity in Elderly Lymphoma Patients: A Prospective Pilot Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4843-4843
Author(s):  
Anca Prica ◽  
Vinita Dhir ◽  
Manjula Maganti ◽  
Vishal Kukreti ◽  
John Kuruvilla ◽  
...  
Keyword(s):  
Grip Strength ◽  
Risk Score ◽  
Older Patients ◽  
Research Funding ◽  
Systemic Chemotherapy ◽  
Performance Tests ◽  
Chemotherapy Toxicity ◽  
Grade 3 ◽  
Over Time ◽  
Frailty Score

Abstract Introduction: Treatment of lymphoma, while subtype specific, often includes curative intent combination chemotherapy. There is little evidence on which to base treatment decisions for older patients, and oncologists often rely on their clinical impression and the patient's chronologic age to make treatment decisions. Objective measures may be more accurate and reproducible in predicting eligibility for combination chemotherapy; however their utility in the clinical setting is still under investigation. Objective: The objectives of this pilot study were to assess the feasibility of applying the Hurria (Hurria et al. JCO 2011) and CRASH (Extermann et al. Cancer 2012) chemotherapy toxicity risk stratification measures, as well as physical performance tests, during busy outpatient clinics, and their ability to potentially predict chemotherapy toxicity. Methods: This is a prospective, single centre pilot feasibility study in patients 70 years of age or older, with lymphoma, planned for definitive systemic chemotherapy. Patients completed geriatric tools (eg. Hurria and CRASH questionnaires, gait speed test and grip strength, CSHA Clinical Frailty Scale and Charlson Comorbidity Index) at baseline. Physical performance tests were repeated with each treatment cycle and data were collected on toxicities, hospital admissions, as well as change in treatment cycles or dosing. Primary outcomes were feasibility and time needed to complete the measures; secondary outcomes were correlation between chemotherapy toxicity and geriatric assessment results, and other patient characteristics (stage and ECOG status). Results: Thirty patients have been enrolled to date (out of a target of 30), and 29 have completed all follow-up assessments, with a median age of 77 yrs (range 69-90) for the whole group, and 59% being male. Diagnosis was diffuse large B cell lymphoma in most (59%), followed by CLL (17%), indolent lymphoma (10%), and other (14%). Chemotherapy treatments most commonly included RCHOP (59%), and bendamustine and rituximab (24%). Aggressive histology pts received G-CSF as 1° prophylaxis. The chemotherapy was dose reduced by the treating physician at cycle 1 in 8 patients (28%), and during the course of treatment in 3 pts (10%). Using the Hurria risk stratification score, 7 pts (24%) were low, 17 (59%) were intermediate and 5 (17%) high risk for chemotherapy toxicity. Similarly, the CRASH scoring identified 2 pts (7%) as low, 11 (38%) as medium-low, 14 (48%) as medium-high and 2 (7%) as high risk. The median amount of time needed to complete the Hurria tool was 2 min (1-5 min) vs. 20 min (5-30min) for the CRASH score. Fourteen pts (48%) experienced CTCAE grade 3-5 toxicity, for a total of 25 severe AEs. The most common gr ≥3 AEs was febrile neutropenia (4 pts), anemia and thrombocytopenia (3pts each); other severe AEs, such as upper GI bleed, PE and DVT, rapid atrial fibrillation, and hyponatremia occurred in one pt each. Dose delays occurred in 9 pts (31%) and 5 pts (17%) required hospitalization due to toxicity. The CSHA frailty score and grip strength worsened throughout treatment and had not recovered by the 1 month visit post-treatment, while the 6 meter walk time did not significantly vary over time during treatment (Figure 1). On univariate analysis, the CSHA frailty score and grip strength changes over time, and the Hurria risk score at baseline were significantly associated with any adverse event, while only the CSHA frailty score and Hurria risk score were associated with Grade 3 or higher events (Tables 1 and 2). On multivariate analysis, the CSHA Frailty score and Hurria risk score retained significance for any AE, however when adjusted for CSHA Frailty, the Hurria score was no longer a significant predictor. Conclusion: When perceived fit older patients are treated with full-dose systemic chemotherapy, the rate of toxicity is high. The Hurria tool, takes a short time to administer, and while not previously tested in lymphoma patients, appears to predict toxicity. The CSHA Frailty was the most robust predictor of chemotherapy toxicity in our patient population, and is a very simple measure to administer. The results of this pilot has led us to recommend routine use of these tools in all older lymphoma patients undergoing systemic chemotherapy at our centre, with the aim of further testing their ability to predict chemotherapy toxicity and treatment outcomes, as well as help plan co-interventions. Disclosures Kuruvilla: Abbvie: Consultancy; Princess Margaret Cancer Foundation: Research Funding; Leukemia and Lymphoma Society Canada: Research Funding; Lundbeck: Honoraria; BMS: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Amgen: Honoraria; Roche: Consultancy, Honoraria, Research Funding; Karyopharm: Honoraria; Merck: Consultancy, Honoraria; Celgene: Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Gilead: Consultancy, Honoraria. Crump:Jansen-Ortho: Consultancy; F. Hoffmann-La Roche Ltd: Consultancy; Servier Canada: Consultancy.

scholarly journals The Controversy of Hydatidiform Mole Treatment In Women age ≥ 40 year-old

Medicinus ◽  
2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Gabriella Farah ◽  
Julita D.L Nainggolan
Keyword(s):  
Older Patients ◽  
Economic Status ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Recommended Treatment ◽  
Suction Curettage

<p>Background: Hydatidiform mole or commonly known as molar pregnancy is one of the gestational trophoblastic disease (GTD) caused by an abnormal trophoblast proliferation. About 50% of gestational trophoblast neoplasm (GTN) arises from molar pregnancy. Higher risk of GTN was found in older patient, especially women age ≥40 years old. Management of hydatidiform mole is often faced come challenges, especially in developing country like Indonesia. Although, suction curettage is the most recommended treatment for the evacuation of molar pregnancy, hysterectomy is considerable for women who have completed childbirth and do not wish to preserve their fertility.<br />Case: Here we present case of 48 years old women with hydatidiform mole. Considering the age of the patient and the completion of her childbearing, we decided to do a laparotomy total abdominal hysterectomy for the evacuation of the mole instead of suction curettage. Turned out that this patient had an invasive mole, one of the types of gestational trophoblastic neoplasia.<br />Conclusion: Although suction curettage is the most frequent technique for molar evacuation, hysterectomy is a reasonable option as primary treatment to be performed in older patients and for those who do not wish to preserve their fertility. The other important points such as socio-economic status, education level, and geographical issues should be considered also on managing older patients with hydatidiform mole in developing countries</p>

scholarly journals Cognitive Impairment, Hypoalbuminemia, High CRP Level and Past History of Gastro-Intestinal Ulcer: 4 Markers of Frailty Which Identify Older Patients with Malignant Hemopathies Who Shouldn't Benefit from Chemotherapy

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4756-4756
Author(s):  
Stephanie Dubruille ◽  
Cindy Kenis ◽  
Vincent Thibaud ◽  
Yves Libert ◽  
Michel Delforge ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older Patients ◽  
Functional Decline ◽  
Albumin Level ◽  
Poor Survival ◽  
Frail Patients ◽  
One Year ◽  
To Receive ◽  
Frailty Score

Abstract INTRODUCTION: Major progresses have been achieved to identify older patients with malignant hemopathies who should be treated with standard doses of chemotherapy. However, a reliable frailty score remains urgently needed to better define the unsuspected vulnerable population that does not benefit from chemotherapy. In the literature, three clinical (functional decline, cognitive impairment (CI) and comorbidities) and two biological (low albumin level and high IL-6 level) factors are frequently associated with a poor overall survival (OS) and/or chemotherapy-related toxicities. OBJECTIVE: To investigate the reliability of a simple clinico-biological tool for the screening of frail patients with malignant hemopathies to predict a poor survival (<6 months). METHODS: 285 consecutive patients (65-90yrs) with malignant hemopathies admitted to receive chemotherapy where included in a prospective multicentric study conducted in the Inst. J. Bordet (ULB, Brussels) and in the University Hospitals Leuven (KU, Leuven). A Comprehensive Geriatric Assessment (CGA) was performed. Univariate and multivariate Cox proportional hazards models were used to evaluate the value of functional decline, abnormal cognitive function, comorbidities, low albumin and CRP level to predict 1-year survival. RESULTS: One hundred and ninety-two patients were evaluable for the clinico-biological screening tool (NHL, n=111; CLL, n=19; MM, n=29; AML, n=20; ALL, n=3; LMMC, n=7; MDS, n=3). Eighty-three percent were considered to have a more favorable prognosis (NHL, CLL or MM). Functional decline was associated with abnormal cognitive function (P=0.029) and inflammation (P=0.002). Based on our previous analyses in the Charlson Comorbidity Index we took the strongest prognostic factor: gastro-intestinal (GI) ulcer (P=0.001). A "frailty" scoring system was thus developed, based on our 4 independent predictive factors for poor survival: CI (MMSE<27, n=57), presence of GI ulcer (n=29), low albumin level (alb<3.5g/dl, n=57) and surrogate marker of IL-6 level (CRP≥2mg/l, n=146). The population was stratified into 3 groups: "fit" (score=0-1, n=102), "vulnerable" (score=2, n=58) and "frail" (score=3-4, n=32). The one-year survival was 80% in "fit" and 53% in "vulnerable" patients (HR=2.75; 95% CI=1.54-4.91; P=.001). In "frail" patients 38% were alive at one-year (HR=4.87; 95% CI=2.61-9.09; P<.001) with a median survival of 5 months. Causes of death remain disease-related in a majority of the patients (69%). CONCLUSIONS: In our selected population of "clinically fit patients" referred to receive chemotherapy for malignant hemopathies, our frailty score helps the clinician to predict a very poor outcome. This frailty score detects unsuspected frailty in patients who may benefit from palliative care. Ongoing prospective analyses in a larger cohort of malignant hemopathies will be updated to validate the reliability of this score. Disclosures Delforge: Amgen, Celgene, Janssen and Takeda: Consultancy; Celgene and Janssen: Research Funding.

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