The Feasibility of Inpatient Geriatric Assessment for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia

作者：Klepin Heidi D^*; Geiger Ann M; Tooze Janet A; Kritchevsky Stephen B; Williamson Jeff D; Ellis Leslie R; Levitan Denise; Pardee Timothy S; Isom Scott; Powell Bayard L

来源：Journal of the American Geriatrics Society, 2011, 59(10): 1837-1846.

DOI：10.1111/j.1532-5415.2011.03614.x

• geriatric assessment
• acute myelogenous leukemia
• cancer
• functional status
• elderly

OBJECTIVES: To test the feasibility and utility of a bed-side geriatric assessment (GA) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia (AML).
DESIGN: Prospective observational cohort study. SETTING: Single academic institution.
PARTICIPANTS: Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy.
MEASUREMENTS: Bedside GA was performed during inpatient exmination for AML. GA measures included the modified Mini-Mental State Examination; Center for Epidemiologic Studies Depression Scale; Distress Thermometer, Pepper Assessment Tool for Disability (includes self-reported activities of daily living (ADLs), instrumental ADLs, and mobility questions); Short Physical Performance Battery (includes timed 4-m walk, chair stands, standing balance); grip strength, and Hematopoietic Cell Transplantation Comorbidity Index.
RESULTS: Of 54 participants (mean age 70.8 +/- 6.4) eligible for this analysis, 92.6% completed the entire GA battery (mean time 44.0 +/- 14 minutes). The following impairments were detected: cognitive impairment, 31.5%; depression, 38.9%; distress, 53.7%; impairment in ADLs, 48.2%; impaired physical performance, 53.7%; and comorbidity, 46.3%. Most were impaired in one (92.6%) or more (63%) functional domains. For the 38 participants rated as having good performance status according to standard oncologic assessment (Eastern Cooperative Oncology Performance Scale score <= 1), impairments in individual GA measures ranged from 23.7% to 50%. Significant variability in cognitive, emotional, and physical status was detected even after stratification according to tumor biology (cytogenetic risk group classification).
CONCLUSION: Inpatient GA was feasible and added new information to standard oncology assessment, which may be important for stratifying therapeutic risk in older adults with AML. J Am Geriatr Soc 59:1837-1846, 2011.

• 出版日期2011-10