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
View DOI

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. 

Comments

Hi, this is an interesting piece of work. The breakdown of frailty needs by percentage is good to reflect on. 

Submitted by natashalander_21519 on

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Thank you, yes, this is an added advantage of the EFS in my opinion - helping to characterise the needs of a cohort to support workforce planning to ensure the right skills and service development.

A very interesting poster, highlighting the challenges when working in the common crossover between frailty and oncology. It would be interesting to learn whether your findings are applicable to other cancer types as well.

Submitted by lowri.edwards1_43717 on

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Thank. There is some evidence of EFS in some cancer groups but often used in more general settings. The G8 is the commonest used in oncology settings but the outcome is ‘may benefit from CGA’ or not. As the EFS aligns closely with CGA clinical domains, I suspect it would. Happy to share our questionnaire if you’re tempted to give it a go!

Really great poster. I have worked with a consultant geriatrician in orthopaedic pre-op assessment clinics where the Edmonton Frail Scale is used - useful to see that it has applications across different specialities in the liaison context! Also really interesting to think about how "frailty" which can sometimes feel like a very obvious but nebulous term can be scored or considered in a more robust manner.

Submitted by charlotte.haye… on

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Good poster.It highlights that EFS provides a more clinically meaningful, multidimensional assessment of frailty in myeloma patients. It supports the need for dynamic frailty evaluation and MDT-led interventions to optimise treatment tolerance and outcome.


 

Submitted by vinodpkuk@gmail.com on

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This is really interesting—particularly the finding that EFS aligns with expert opinion while CFS doesn’t. It highlights how a multidimensional tool may better capture the complexity of frailty in myeloma, especially given how dynamic and potentially reversible frailty is.

Submitted by danyalkayani_34710 on

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I think it comes down to CFS predicting the risk of frailty being present and indicating those who may benefit from CGA, whereas EFS is more clinically aligned in its domains with the CGA itself. 

Submitted by joanna.preston on

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This is a good poster. It is interesting that EFS is better than CFS and I believe this need to be compared in further prospective studies

Submitted by moh.mort89_47757 on

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Thanks, as with comment above, I think the difference is that CFS is a risk stratification tool, but we’ve got used to using it as shorthand for diagnosis of frailty. It is also simpler and quicker to do than EFS. So it’s about which we choose for the task in hand. 

Submitted by joanna.preston on

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