Older adults with blood cancers: How they fare

Although the majority of patients who have blood cancers are older adults, they make up only a small percentage of participants in the clinical trials that lead to new therapies. That's because the standard research methods used in oncology (cancer medicine) are not ideal for identifying certain vulnerabilities linked to aging, such as having multiple chronic diseases and being frail.

To help remedy that situation, the American Society of Clinical Oncology (ASCO) issued a guideline recommending that older adults who have cancer receive a geriatric assessment to see if they are at increased risk for experiencing side effects from medication and other complications from cancer and its treatment. Recently, a team of researchers examined older adults who have cancer to see whether their ability to manage daily activities as measured by these assessments was linked to staying alive longer. The team published their study in the Journal of the American Geriatrics Society.

A key part of the geriatric assessment is to determine how well an older adult performs the basic activities of daily living (ADLs). These include bathing, dressing, getting themselves from a chair to the bed (and vice versa), eating, grooming, and using the toilet. The geriatric assessment also takes into account an older adult's ability to perform instrumental activities of daily living (IADLS), or activities necessary for them to live on their own in the community. These activities include shopping, preparing meals, housework, taking medication, and handling their finances.

The researchers studied how performing daily activities was linked to survival and also to the use of medical care for adults living with cancer and aged 75 years and older. The researchers suspected that being unable to perform their daily activities would mean higher rates of death and unexpected visits to the Emergency Department (ED) and admissions to the hospital.

Participants included 464 people who on average were nearly 80 years old; 65 percent were male. All the participants were treated for blood cancers, including leukemia, multiple myeloma, and lymphoma, at the Dana-Farber Cancer Institute in Boston. About 38 percent of the participants had an aggressive form of blood cancer.

Of the participants, 11 percent reported they had trouble with at least one ADL and almost 27 percent had trouble performing at least one IADL.

The researchers also looked at a group of 318 participants who had visited the ED or had unplanned hospitalizations. Of them, 17 percent had at least one ED visit and 19 percent had at least one unplanned hospitalization. The five most common causes of hospitalization were pneumonia, fever, sepsis (the medical term for a blood infection), pain, and congestive heart failure.

For their main findings, the researchers reported that participants who had trouble performing at least one IADL had a higher risk for death, ED visits, and unplanned hospitalizations. This risk was not affected by how old they were, whether they had other chronic illnesses, how aggressive their cancers were, or the intensity of their cancer treatment.

What's more, the researchers found that many of the patients who were dependent in performing their IADLS (meaning they relied on help from others) also had higher rates of age-related conditions, such as memory issues, problems with mobility, and feelings of loneliness or depression. The researchers concluded from their study that it is not only important to ask about function for older adults with blood cancer but to also screen for age-related conditions that could limit functioning. Treating these other conditions to improve function might help older adults better tolerate the stress of blood cancers and their treatment, the researchers suggested.

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This summary is from "Function, Survival, and Care Utilization Among Older Adults with Hematologic Malignancies." It appears online ahead of print in Journal of the American Geriatrics Society. The study authors are Clark DuMontier, MD; Michael A. Liu, MPH; Anays Murillo, MPH; Tammy Hshieh, MD, MPH; Houman Javedan, MD; Robert Soiffer, MD; Richard M. Stone, MD; Jane A. Driver, MD, MPH; and Gregory A. Abel MD, MPH.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.