Geriatric Assessment Better Than Chronologic Age for Measuring Health-Related Quality of Life in NHL

Chronological age appears to have no impact on baseline or longitudinal health-related quality of life (HRQOL) in patients with non-Hodgkin lymphoma (NHL) highlighting the need for clinicians to incorporate geriatric assessment (GA) into clinical practice instead of relying on age alone, according to new prospective study presented at  the 2021 American Society of Hematology (ASH) Annual Meeting.

New oral targeted therapies (OTTs) have significantly improved the care of patients with NHL; however, older adults may be more vulnerable to treatment-related adverse effects. GA has been shown to be helpful for predicting chemotherapy-related toxicity in older adults, and it also can help detect geriatric impairments associated with poor HRQOL.

The researchers conducted a prospective study with 25 patients, median age 77 years (range, 71 to 93 years). Patients were followed monthly for the first 3 months, then every 3 months for 12 months, with follow-up for a median 6.3 months (range, 2.7 to 8.8). The most common diagnosis was chronic lymphocytic leukemia (21 patients), followed by mantle cell lymphoma (3 patients), and marginal zone lymphoma (1 patient).

At study entry, 72% of patients were on an OTT, with the most common agents being ibrutinib (17 patients) and venetoclax (5 patients). GA revealed the presence of a geriatric syndrome (GS) in more than 90% of patients. It also detected cognitive impairment (28%), depression (24%), polypharmacy (92%), and recent falls (12%).

Dependence in independent activities of daily living (ADLs) was associated with inferior global health status scores (69.1 vs 86.1; P =.023) and physical functioning scores (66.7 vs 88.1; P =.008) at baseline.  Study results showed that dependence in 2 or more ADLs was associated with lower baseline physical functioning scores (57.8 vs 88.0; P =.003) and role functioning scores (61.1 vs 90.8; P =.030).

There was significant worsening of global health status (mean difference, -5.4; P =.024) and cognitive functioning scores (mean difference, -9.6; P <.001) during the 6-month follow-up for all participants. The trends for symptom scores were mixed with improvement in some scores (pain, fatigue) and worsening of others (dyspnea, diarrhea, and constipation). However, none were deemed to be clinically relevant.

The researchers note that geriatric syndromes are common in older adults with NHL (almost half of the patients in this cohort had 2 or more GS). They also found older adults with GS had lower baseline global health status and physical functioning scores. However, these patients experienced greater improvement in symptom scores and maintenance of longitudinal HRQOL compared with those without GS at baseline.

Reference

Akhtar OS, Wang C, Attwood K, et al. Evaluating the role of baseline geriatric assessment in predicting quality of life in older adults with non-Hodgkin lymphoma on oral targeted therapies. Presented at ASH 2021; December 11-14, 2021. Abstract 4094.