A bedside assessment picked up symptoms and impairments that standard oncology assessments do not routinely identify in a group of older persons with acute myelogenous leukemia (AML), according to a study recently published in the Journal of the American Geriatrics Society (2011;59:1837-1846).
A total of 54 adult inpatients (mean age 70.8 years) with newly diagnosed AML were assessed over an 18-month period at Wake Forest Baptist Medical Center, in Winston-Salem, North Carolina, where they were about to begin chemotherapy. The participants were evaluated using the modified Mini-Mental State Examination; the Center for Epidemiologic Depression Scale; the Distress Thermometer; the Pepper Assessment Tool for disability (including self-reported activities of daily living [ADLs], instrumental ADLs, and mobility questions); the Short Physical Performance Battery (including timed 4-meter walk, chair stands, and standing balance); grip strength; and the Hematopoietic Cell Transplantation Comorbidity Index.
Nearly all (92.6%) of the men and women completed the entire battery, which was administered in an average of 44 minutes per patient. The tests identified:
- Distress in 53.7% of patients
- Impaired physical performance in 53.7%
- Impairment in ADLs in 48.2%
- Comorbidity in 46.3%
- Depression in 38.9%
- Cognitive impairment in 31.5%.
Even after patients were stratified by tumor biology, the assessments revealed significant variability in cognitive, emotional, and physical status.
Among the 38 patients who were deemed to have good performance status according to standard oncologic assessment (an Eastern Cooperative Oncology performance scale score of no more than 1), impairments in individual geriatric assessment measures ranged from 23.7% to 50%.
The authors concluded that inpatient geriatric assessment was feasible and added new information to standard oncology assessment that could be important for stratifying therapeutic risk in older adults with AML.