scholarly journals An Analysis of the Inclusion of Medications Considered Potentially Inappropriate in Older Adults in Chemotherapy Templates for Hematologic Malignancies: One Recommendation for All?

Drugs & Aging ◽  
2018 ◽  
Vol 35 (5) ◽  
pp. 459-465
Author(s):  
Amy Zhou ◽  
Holly M. Holmes ◽  
Arti Hurria ◽  
Tanya M. Wildes
Keyword(s):  
Older Adults ◽  
Hematologic Malignancies

scholarly journals Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice

Hematology ◽  
2019 ◽  
Vol 2019 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Heidi D. Klepin
Keyword(s):  
Older Adults ◽  
Quality Of Care ◽  
Geriatric Assessment ◽  
Hematologic Malignancies ◽  
Patient Centered ◽  
Functional Reserve ◽  
Centered Care ◽  
Assessment Measures

Abstract Older adults represent the growing majority of patients diagnosed with hematologic disorders, yet they remain underrepresented on clinical trials. Older patients of the same chronologic age differ from one another with varying comorbidity and functional reserve. The concepts of frailty and resilience are important to patient-centered care and are patient and setting specific. The use of geriatric assessment to inform tailored decision making and management can personalize care for older adults with hematologic malignancies. This article will highlight available evidence to support the role of geriatric assessment measures to enhance quality of care for older adults diagnosed with hematologic malignancies.

scholarly journals Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies

2021 ◽  
Vol 11 ◽  
Author(s):  
Sarah A. Wall ◽  
Ying Huang ◽  
Ashleigh Keiter ◽  
Allesia Funderburg ◽  
Colin Kloock ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Bone Marrow Failure ◽  
Myeloproliferative Neoplasm ◽  
Treatment Decision ◽  
Hematologic Malignancies ◽  
Routine Care ◽  
Clinical Frailty Scale ◽  
Risk Of Death ◽  
Age Related

The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00–1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41–4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60–9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10–6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21–1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05–1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11–4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07–3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.

scholarly journals Individualizing Treatment Decisions for Older Adults with Hematologic Malignancies

2013 ◽  
Vol 33 ◽  
pp. 208-219 ◽  
Author(s):  
Heidi D. Klepin ◽  
David Rizzieri ◽  
Antonio Palumbo ◽  
Valeria Magarotto ◽  
Barbara Eichhorst
Keyword(s):  
Older Adults ◽  
Hematologic Malignancies ◽  
Treatment Decisions

scholarly journals THE ASSOCIATION OF FUNCTION, MOOD, AND LONELINESS WITH SURVIVAL IN OLDER ADULTS WITH HEMATOLOGIC MALIGNANCIES

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 701-701
Author(s):  
C DuMontier ◽  
A Murillo ◽  
M Liu ◽  
T Hshieh ◽  
R Soiffer ◽  
...  
Keyword(s):  
Older Adults ◽  
Hematologic Malignancies

scholarly journals Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies

Haematologica ◽  
2021 ◽  
Author(s):  
Clark DuMontier ◽  
Hajime Uno ◽  
Tammy Hshieh ◽  
Guohai Zhou ◽  
Richard Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Standard Care ◽  
Controlled Trial ◽  
Hematologic Malignancies ◽  
Care Utilization ◽  
Goals Of Care ◽  
Randomized Controlled ◽  
Geriatric Consultation ◽  
The Impact

We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients age ii75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficitaccumulation approaches, were randomized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end of life (EOL) goals of care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consultation plus standard care (n = 60) or standard care alone (n = 100). Median age was 80.4 years (SD = 4.2). Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at one year compared to standard care (difference: 2.9%, 95% CI = -9.5% to 15.2%, p = 0.65), and did not significantly reduce the incidence of ED visits, hospitalizations, or days in hospital. Consultation did improve the odds of having EOL goals of care discussions (odds ratio = 3.12, 95% CI = 1.03 to 9.41) and was valued by surveyed hematologiconcology clinicians, with 62.9%-88.2% rating consultation as useful in the management of several geriatric domains.

scholarly journals Delivering intensive therapies to older adults with hematologic malignancies: strategies to personalize care

Blood ◽  
2019 ◽  
Vol 134 (23) ◽  
pp. 2013-2021
Author(s):  
Rebecca L. Olin
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Clinical Management ◽  
Hematologic Malignancies

These 2 reviews respectively examine the value and utility of geriatric assessment (GA) tools and discuss the role of GA in the clinical management of patients with hematologic malignancies.

scholarly journals Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

2020 ◽  
Vol 10 (3) ◽  
pp. 106
Author(s):  
Fernando Ramos ◽  
Paola González-Carmona ◽  
María Isabel Porras-Guerra ◽  
Sonia Jiménez-Mola ◽  
Ana María Martínez-Peláez ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
General Condition ◽  
Performance Status ◽  
Daily Practice ◽  
Hematologic Malignancies ◽  
Adult Patients ◽  
Systematic Evaluation ◽  
Clinical Team ◽  
Ecog Performance Status

Several societies have published recommendations for evaluating older adults with cancer in standard conditions. It is vital to assure a proper systematic patient condition evaluation, not only in the oldest (geriatric assessment) but in all adult patients. We have investigated the feasibility of a systematic evaluation of the general condition of all patients diagnosed with hematologic malignancies, and the degree of acceptance by the clinical team, in a prospective cohort of 182 consecutive adults, by using the ECOG performance status scale (ECOG, age 18 and over, 18+), Lee Index for Older Adults (LEE, 50+), Geriatric Assessment in Hematology (GAH, 65+), and the Comprehensive Geriatric Assessment (CGA, 75+). Clinical team acceptance was analyzed with a visual analogue scale, and the objective feasibility was calculated as the proportion of patients that could be finally evaluated with each tool. Acceptance was high, but the objective feasibility was progressively lower as the complexity of the different tools increased (ECOG 100%, LEE 99.4%, GAH 93.2%, and CGA 67.9%). LEE and GAH categories showed a weak concordance (Cohen’s Kappa 0.24) that was slight between LEE and CGA (Kappa 0.18). Unexpectedly, we found no significant association between the GAH and CGA categories (p = 0.16). We confirm that a systematic evaluation of all adult patients diagnosed with hematologic malignancies is feasible in daily practice by using an age-adapted approach. Direct comparisons among the different predictive tools in regard to patients’ tolerance to treatments of different intensities must be a priority research subject in the coming years.

Individualizing Treatment Decisions for Older Adults with Hematologic Malignancies

2013 ◽  
pp. 208-219
Author(s):  
Heidi D. Klepin ◽  
David Rizzieri ◽  
Antonio Palumbo ◽  
Valeria Magarotto ◽  
Barbara Eichhorst
Keyword(s):  
Older Adults ◽  
Treatment Options ◽  
Allogeneic Bone Marrow Transplantation ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Hematologic Malignancies ◽  
Lymphocytic Leukemia ◽  
Allogeneic Bone ◽  
Functional Impairments ◽  
Therapeutic Decisions

Hematologic malignancies are a common cause of morbidity and mortality among older adults, who represent the majority of patients diagnosed with these diseases. Treatment options and disease outcomes have improved in recent years because of the development of novel treatment strategies and the design of elderly-specific clinical trials. Despite this, extrapolation of clinical trial data to patients routinely seen in practice is challenging because of the presence of multimorbidity and functional impairments. Individualized treatment decision making requires not only an understanding of underlying tumor biology but also careful estimation of an older patient's anticipated ability to withstand the stresses of therapy. This article will discuss approaches to standardizing patient assessment strategies and tailoring therapeutic decisions for older adults with hematologic malignancies with a focus on acute myeloid leukemia (AML), allogeneic bone marrow transplantation, multiple myeloma (MM), and chronic lymphocytic leukemia (CLL).

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