Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes

Angela Molga, Michelle Wall, Rakchha Chhetri, Li Yan Wee, Deepak Singhal, Suzanne Edwards, Nimit Singhal, David Ross, Luen Bik To, Gillian Caughey, Sepehr Shakib, Ulrich Germing, Timothy To, Devendra Hiwase

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Treatment of older patients with myelodysplastic syndrome (MDS) is based on disease biology and performance status. Performance status, however, does not reflect increasing co-morbidities, functional dependence or psychosocial issues in older patients. Patients and Methods: This prospective study evaluated the burden of geriatric related health issues, assessed feasibility of “tailored” Comprehensive Geriatric Assessment (CGA), and compared treatment duration and survival in older patients with MDS and oligoblastic acute myeloid leukemia with and without deficits in CGA domains (n = 98). Results: Although only 27 (28%) patients had an Eastern Cooperative Oncology Group score ≥2, 78% (n = 77) patients had deficits in at least one CGA domain. Deficits were spread across all CGA domains, including dependence for instrumental activity of daily living (iADL; n = 33, 34%). Importantly, patients who were dependent for iADL (3.7 ± 2.6 vs 12.1 ± 7.9; p =. 009), had cognitive impairment (3.5 ± 2.1 vs. 10.9 ± 7.9; p =. 034) or impaired mobility (3.8 ± 2.5 vs. 13.2 ± 7.6; p =. 001) completed significantly less azacitidine cycles as compared to those without these deficits. Cox-proportional regression showed that iADL dependency (hazard ratio 3.37; p =. 008) and higher comorbidities (hazard ratio 4.7; p <. 001) were associated with poor prognosis independent of disease related factors. Poor survival of iADL dependent patients was seen in both azacitidine (6 vs 19 months; p <. 001) and supportive care cohorts (26 vs 48 months; p =. 01). Conclusion: CGA detected geriatric related health issues, predicted poor survival and identified patients less likely to continue and benefit from azacitidine. Hence, CGA should be included in the treatment decision algorithm of older patients with MDS.

LanguageEnglish
Pages114-120
Number of pages7
JournalJournal of Geriatric Oncology
Volume11
Issue number1
DOIs
Publication statusPublished - 1 Jan 2020

Keywords

  • Azacitidine
  • Comprehensive geriatric assessment
  • Frailty
  • Myelodysplastic syndrome

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

Cite this

Molga, Angela ; Wall, Michelle ; Chhetri, Rakchha ; Wee, Li Yan ; Singhal, Deepak ; Edwards, Suzanne ; Singhal, Nimit ; Ross, David ; To, Luen Bik ; Caughey, Gillian ; Shakib, Sepehr ; Germing, Ulrich ; To, Timothy ; Hiwase, Devendra. / Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes. In: Journal of Geriatric Oncology. 2020 ; Vol. 11, No. 1. pp. 114-120.
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abstract = "Background: Treatment of older patients with myelodysplastic syndrome (MDS) is based on disease biology and performance status. Performance status, however, does not reflect increasing co-morbidities, functional dependence or psychosocial issues in older patients. Patients and Methods: This prospective study evaluated the burden of geriatric related health issues, assessed feasibility of “tailored” Comprehensive Geriatric Assessment (CGA), and compared treatment duration and survival in older patients with MDS and oligoblastic acute myeloid leukemia with and without deficits in CGA domains (n = 98). Results: Although only 27 (28{\%}) patients had an Eastern Cooperative Oncology Group score ≥2, 78{\%} (n = 77) patients had deficits in at least one CGA domain. Deficits were spread across all CGA domains, including dependence for instrumental activity of daily living (iADL; n = 33, 34{\%}). Importantly, patients who were dependent for iADL (3.7 ± 2.6 vs 12.1 ± 7.9; p =. 009), had cognitive impairment (3.5 ± 2.1 vs. 10.9 ± 7.9; p =. 034) or impaired mobility (3.8 ± 2.5 vs. 13.2 ± 7.6; p =. 001) completed significantly less azacitidine cycles as compared to those without these deficits. Cox-proportional regression showed that iADL dependency (hazard ratio 3.37; p =. 008) and higher comorbidities (hazard ratio 4.7; p <. 001) were associated with poor prognosis independent of disease related factors. Poor survival of iADL dependent patients was seen in both azacitidine (6 vs 19 months; p <. 001) and supportive care cohorts (26 vs 48 months; p =. 01). Conclusion: CGA detected geriatric related health issues, predicted poor survival and identified patients less likely to continue and benefit from azacitidine. Hence, CGA should be included in the treatment decision algorithm of older patients with MDS.",
keywords = "Azacitidine, Comprehensive geriatric assessment, Frailty, Myelodysplastic syndrome",
author = "Angela Molga and Michelle Wall and Rakchha Chhetri and Wee, {Li Yan} and Deepak Singhal and Suzanne Edwards and Nimit Singhal and David Ross and To, {Luen Bik} and Gillian Caughey and Sepehr Shakib and Ulrich Germing and Timothy To and Devendra Hiwase",
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Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes. / Molga, Angela; Wall, Michelle; Chhetri, Rakchha; Wee, Li Yan; Singhal, Deepak; Edwards, Suzanne; Singhal, Nimit; Ross, David; To, Luen Bik; Caughey, Gillian; Shakib, Sepehr; Germing, Ulrich; To, Timothy; Hiwase, Devendra.

In: Journal of Geriatric Oncology, Vol. 11, No. 1, 01.01.2020, p. 114-120.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes

AU - Molga, Angela

AU - Wall, Michelle

AU - Chhetri, Rakchha

AU - Wee, Li Yan

AU - Singhal, Deepak

AU - Edwards, Suzanne

AU - Singhal, Nimit

AU - Ross, David

AU - To, Luen Bik

AU - Caughey, Gillian

AU - Shakib, Sepehr

AU - Germing, Ulrich

AU - To, Timothy

AU - Hiwase, Devendra

PY - 2020/1/1

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N2 - Background: Treatment of older patients with myelodysplastic syndrome (MDS) is based on disease biology and performance status. Performance status, however, does not reflect increasing co-morbidities, functional dependence or psychosocial issues in older patients. Patients and Methods: This prospective study evaluated the burden of geriatric related health issues, assessed feasibility of “tailored” Comprehensive Geriatric Assessment (CGA), and compared treatment duration and survival in older patients with MDS and oligoblastic acute myeloid leukemia with and without deficits in CGA domains (n = 98). Results: Although only 27 (28%) patients had an Eastern Cooperative Oncology Group score ≥2, 78% (n = 77) patients had deficits in at least one CGA domain. Deficits were spread across all CGA domains, including dependence for instrumental activity of daily living (iADL; n = 33, 34%). Importantly, patients who were dependent for iADL (3.7 ± 2.6 vs 12.1 ± 7.9; p =. 009), had cognitive impairment (3.5 ± 2.1 vs. 10.9 ± 7.9; p =. 034) or impaired mobility (3.8 ± 2.5 vs. 13.2 ± 7.6; p =. 001) completed significantly less azacitidine cycles as compared to those without these deficits. Cox-proportional regression showed that iADL dependency (hazard ratio 3.37; p =. 008) and higher comorbidities (hazard ratio 4.7; p <. 001) were associated with poor prognosis independent of disease related factors. Poor survival of iADL dependent patients was seen in both azacitidine (6 vs 19 months; p <. 001) and supportive care cohorts (26 vs 48 months; p =. 01). Conclusion: CGA detected geriatric related health issues, predicted poor survival and identified patients less likely to continue and benefit from azacitidine. Hence, CGA should be included in the treatment decision algorithm of older patients with MDS.

AB - Background: Treatment of older patients with myelodysplastic syndrome (MDS) is based on disease biology and performance status. Performance status, however, does not reflect increasing co-morbidities, functional dependence or psychosocial issues in older patients. Patients and Methods: This prospective study evaluated the burden of geriatric related health issues, assessed feasibility of “tailored” Comprehensive Geriatric Assessment (CGA), and compared treatment duration and survival in older patients with MDS and oligoblastic acute myeloid leukemia with and without deficits in CGA domains (n = 98). Results: Although only 27 (28%) patients had an Eastern Cooperative Oncology Group score ≥2, 78% (n = 77) patients had deficits in at least one CGA domain. Deficits were spread across all CGA domains, including dependence for instrumental activity of daily living (iADL; n = 33, 34%). Importantly, patients who were dependent for iADL (3.7 ± 2.6 vs 12.1 ± 7.9; p =. 009), had cognitive impairment (3.5 ± 2.1 vs. 10.9 ± 7.9; p =. 034) or impaired mobility (3.8 ± 2.5 vs. 13.2 ± 7.6; p =. 001) completed significantly less azacitidine cycles as compared to those without these deficits. Cox-proportional regression showed that iADL dependency (hazard ratio 3.37; p =. 008) and higher comorbidities (hazard ratio 4.7; p <. 001) were associated with poor prognosis independent of disease related factors. Poor survival of iADL dependent patients was seen in both azacitidine (6 vs 19 months; p <. 001) and supportive care cohorts (26 vs 48 months; p =. 01). Conclusion: CGA detected geriatric related health issues, predicted poor survival and identified patients less likely to continue and benefit from azacitidine. Hence, CGA should be included in the treatment decision algorithm of older patients with MDS.

KW - Azacitidine

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KW - Frailty

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