Predicting Health Outcomes in Older Patients with Hematologic Cancers

Gait speed and grip strength are objective measures of physical health that have been shown to predict important health outcomes in older adults such as functional decline, acute care use and death. According to a recent study, these measures are particularly important to assess in older patients with hematologic malignancies including leukemia, lymphoma and multiple myeloma.

The study was conducted by researchers from the Older Adult Hematologic Malignancy Program, a collaboration between Brigham and Women’s Hospital and Dana-Farber Cancer Institute, which was created to address the specialized needs of blood cancer patients aged 75 and older.

“A healthy gait and grip require normal cognitive functioning; an intact nervous, muscular and skeletal system; and healthy cardiopulmonary function,” explained co-author Clark DuMontier, MD, a geriatrician and research fellow at Brigham and Women’s Hospital, Division of Aging. “Those domains are often compromised in older adults with hematological malignancies, so measuring gait speed and grip strength provides an important window into their health status.”

The Predictive Value of Gait Speed

The study found that gait speed, which can be measured in less than a minute, carries similar predictive value in reflecting aging-related vulnerabilities as multi-domain measures of frailty, which can take 20 minutes or longer to assess. Every 0.1 meter-per-second decrease in patients’ gait speed was associated with increased hazard ratios for death, including a 33 percent increase in the odds of unplanned hospitalizations and a 34 percent increase in the odds of ED visits. The finding applied to all older blood cancer patients, regardless of their cancer aggressiveness or intensity of their treatment.

“Gait speed is both simple to measure and powerful,” Dr. DuMontier said. “It can carry just as much if not more weight to the patient’s prognosis as cancer stage and other cancer-specific measures.”

A 5 kg decrease in grip strength, primarily a measure of physical function useful with non-ambulatory patients, was associated with a 24 percent increase in rate of death. Grip strength was not associated with the odds of ED visits or unplanned hospitalizations.

Implementing the Functional Vital Signs

According to Dr. DuMontier, while guidelines recommend geriatric assessment for all older adults with cancer, it has not been widely implemented in oncology practice due to time, expertise and other barriers. However, he and his colleagues hope their study will justify implementing simple measures such as gait speed and grip speed that integrate many of the domains of the geriatric assessment.

“Gait speed and grip strength are often performed in rehabilitation therapy or as part of a geriatric assessment,” he said. “However, they are functional vital signs that can be easily measured and interpreted in any clinical setting, even in the absence of a geriatrician.”

In addition to collaborating with oncologists to expand the use of gait speed and grip strength assessments to their patients, the Brigham’s Division of Aging works with primary care and other medical and surgical subspecialties to practice and study innovative ways of incorporating geriatrics into routine care for older adults.

“The Brigham’s support for these efforts shows its willingness to lead the way in promoting healthy aging and optimizing both quantity and quality of life for older adults,” Dr. DuMontier concluded.