Assessing Frailty and Vulnerability in Older Adults with Cancer

Geriatric assessment in older adults with acute myeloid leukemia: A Young International Society of Geriatric Oncology narrative review

The therapeutic landscape of acute myeloid leukemia (AML) in older adults has been transformed by the advent of targeted therapies, including venetoclax (a B-cell lymphoma-2 inhibitor), gilteritinib (a FMS-like tyrosine kinase 3 inhibitor), ivosidenib, and enasidenib (isocitrate dehydrogenase 1/2 inhibitors). These agents, in combination with hypomethylating agents, have significantly improved outcomes among patients aged 60 years and older, however, overall survival remains very poor. Hence, the management of AML in this population requires a nuanced approach to balance overall survival, treatment-related toxicities, quality of life, and the preservation of functional independence. In recent years, geriatric assessment (GA) has emerged as a critical strategy to identify vulnerabilities that may not be captured in routine oncology evaluations. This assessment helps guide tailored interventions to optimize the fitness of older adults, allowing for better risk stratification and thereby informing treatment plans. This review discusses available evidence for each domain within the GA, feasibility of GA in clinical trials, and gaps in knowledge and future directions to fill those gaps.

Frailty and its association with health-related quality of life among older cancer patients: an evidence-based study from China

BACKGROUND

There is limited information about the population characteristics and adverse health outcomes of older cancer patients in China. This study aimed to describe the prevalence of frailty and examine the association between frailty and health-related quality of life (HRQoL) among older cancer patients.

METHODS

This was a cross-sectional study involving older patients diagnosed with cancer in two tertiary hospitals in Shandong Province, China. Frailty was assessed using Geriatric 8 (G-8). HRQoL was measured using the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire. The Tobit regression model and logistic regression model was used to identify the relationship between frailty and HRQoL.

RESULTS

Of the 229 older patients, 175 (76.4%) were frail. Frail patients had lower EQ-5D-5L utility scores than those who were non-frail (0.830 vs. 0.889; P = 0.004). After adjustments for sociodemographic and cancer-related variables, frailty was statistically associated with worse health-related quality of life (OR = 6.024; P = 0.001).

CONCLUSION

Frailty was associated with deteriorated HRQoL in older patients with cancer. Early frailty screening and preventive interventions are essential for improving quality of life through decision-making or pretreatment optimization in geriatric oncology.

Geriatric Assessment in Older Patients with Acute Myeloid Leukemia

The incidence of acute myeloid leukemia (AML) increases with age, but the outcomes for older adults with AML are poor due to underlying tumor biology, poor tolerance to aggressive treatment, and the physiologic changes of aging. Because of the underlying heterogeneity in health status, treatment decisions are difficult in this population. A geriatric assessment (GA) refers to the use of various validated tools to assess domains that are important in older adults including physical function, cognition, comorbidities, polypharmacy, social support, and nutritional status. In older patients with cancer, a GA can guide treatment decision-making, predict treatment toxicity, and guide supportive care interventions. Compared to solids tumors, there is a relative lack of studies evaluating the use of a GA in older patients with AML. In this review, we will discuss the principles, common domains, feasibility, and benefits of GA, with a focus on older patients with AML that includes practical applications for clinical management.