The degree of a patient’s frailty has a significant impact on therapeutic outcomes; however, measuring frailty through a comprehensive assessment with a trained geriatrician is not common practice. In this review, the authors outline how hematologists can make better treatment recommendations for their patients by incorporating several easy-to-use frailty assessment tools into their practice.
Most frailty assessments include a self-administered questionnaire with an administered component (e.g., cognitive, physical performance) that is typically performed by a nurse or other trained professional. Frailty assessment tools with validated prognostic utility include:
- Clinical Frailty Scale
- International Myeloma Working Group frailty score
- Vulnerable Elders Survey
- Geriatric Assessment in Hematology (GAH) Scale
The authors review research results that demonstrate the effect of frailty among specific blood cancers, including multiple myeloma, myelodysplastic syndromes, acute myeloid leukemia, chronic lymphocytic leukemia and lymphoma. Frailty has also been associated with poor therapeutic response, increased toxicity and worse survival.
Finally, the authors propose a new research agenda for geriatric hematology that includes:
- Using rigorous frailty screening, instead of age limits
- Developing disease-specific measures
- Adding functional and patient-reported outcomes alongside survival
- Including older patients and rigorous frailty assessments into clinical trials