Frailty Assessment & Needs in Older Adults with Myeloma

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Joanna Preston1, Fenella Willis2, Yasmin Reyal2, Theodora Vatopoulou2, Angelica Edge2, Jay Parekh2, Reena Kaur1, Haleema S Adil1.
1. Senior Health Department, St. Georges University Hospital, London, UK. 2. Haematology Department, St. Georges University Hospital, London, UK.
Scientific Research
SP - Other medical conditions
Cancer

Abstract

Background & Aim

We present findings from a joint Geriatrician and Haematologist Myeloma clinic pilot, specifically a) frailty needs of the cohort and b) performance of frailty screening tools including International Myeloma Working Group Frailty Index (IMWG-FI, Performance Status (PS), Geriatric 8 (G8), Clinical Frailty Score (CFS) and Edmonton Frail Scale (EFS), against expert opinion of frailty.

Methods 

During pre-clinic MDM, patients were flagged for Geriatrician review following concern from either Geriatrician or Haematologist. This review was used to benchmark the presence of frailty by expert opinion.  

Data were collected to calculate the listed frailty scores independently and correlation with expert opinion was examined using Fischer’s exact test. 

Results 

Nineteen defined as frail by expert opinion. Survey completed by 55 patients with a median age of 75 years (range 65-94). 

Tools

Score

Fishers Exact p-value

EFS

0.01

CFS

>0.99

IMWG-FI

0.072

PS

0.377

G8: sensitivity of 100%, specificity: 0% 

 

Frailty Needs

  • Medication-related 83.6%

  • Falls risks 79.9%

  • Nocturia 78.2%

  • Functional 45.5%

  • Sleep 36.4%

  • Isolation 34.5%

  • Vision 34.5%

  • Bladder/bowels 32.7%

  • Cognitive 27.3%

  • Mood 27.3%

  • Hearing 23.6%

  • Loneliness 21.8%

  • ACP 5.5% 

Discussion 

EFS was the only tool to demonstrate statistically significant alignment with expert opinion. The CFS, while widely used as a screening tool in general populations, showed no meaningful correlation in this cohort. 

Frailty is a dynamic state which fluctuates throughout its course. Where tools such as IMWG-FI and ECOG-PS are useful to guide prognosis and treatment selection, EFS facilitates understanding the clinical challenges for an individual, allowing an opportunity to address their intrinsic resilience and the potential to increase their tolerance of optimal treatments.  

Older adults living with myeloma experience a range of frailty needs. Services should include an MDT capable of addressing the frailty related issues faced by this group. 

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