In the Journals

Walking speed, grip strength predict outcomes among older patients with blood cancers

Gregory A. Abel, MD, MPH
Gregory A. Abel

Walking speed appeared to be an important predictor of survival and hospital utilization among older patients with hematologic malignancies, according to results of a prospective study published in Blood.

Additionally, grip strength could predict survival among patients who are unable to walk, researchers noted.

“The slower someone walks, the higher their risk for problems,” Jane A. Driver, MD, MPH, co-director of the Older Adult Hematologic Malignancy Program at Dana-Farber Cancer Institute and associate director of geriatric research education and clinical center at VA Boston Healthcare System, said in a press release. “There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes.”

Driver and colleagues analyzed 448 patients aged 75 years and older (mean age, 79.7 years; 65.2% men) presenting for an initial consultation at hematology clinics affiliated with Dana-Farber Cancer Institute who agreed to have their walking speed and grip strength tested by researchers.

Patients unable to walk (n = 31) had a gait speed recorded as zero.

A majority of patients (62.5%) had an aggressive form of cancer. The most common malignancies included plasma cell neoplasms (30.6%), non-Hodgkin lymphoma (28.6%) and myeloid neoplasms (17.6%).

Investigators measured walking speed using the NIH 4-meter gait speed test, in which patients walked 4 meters at a normal pace and their speed was recorded with a stopwatch.

Results showed that after adjustment for age, cancer type and other factors, every 0.1-meter-per-second decrease in walking speed appeared associated with a higher mortality (HR = 1.22; 95% CI, 1.15-1.3), higher odds of unplanned hospitalizations (OR = 1.33; 95% CI, 1.16-1.51) and higher odds of ED visits (OR = 1.34; 95% CI, 1.17-1.53).

The association between adjusted walking speed and survival outcomes appeared strongest among patients with non-Hodgkin lymphoma (HR = 1.53; 95% CI, 1.25-1.89), followed by patients with other malignancies (HR = 1.38; 95% CI, 1.08-1.75), plasma cell neoplasms (HR = 1.24; 95% CI, 1.03-1.49) and acute myeloid leukemia (HR = 1.21; 95% CI, 1.04-1.41).

Every 5-kg decrease in grip strength appeared associated with worse survival (adjusted HR = 1.24; 95% CI, 1.07-1.43); however, this measure did not affect hospital stays or visits to the ED.

Researchers acknowledged study limitations, including use of data from a single institution and early deaths unrelated to the study.

“Our study reveals that the current standard of care for functional assessment in oncology — performance status — is not sufficient for elders with blood cancers,” Gregory A. Abel, MD, MPH, co-director of the Older Adult Hematologic Malignancy Program at Dana-Farber Cancer Institute, said in a press release. “Gait speed appears to be much better at differentiating those patients at highest risk for poor outcomes.” – by John DeRosier

Disclosures: The authors report no relevant financial disclosures.

Gregory A. Abel, MD, MPH
Gregory A. Abel

Walking speed appeared to be an important predictor of survival and hospital utilization among older patients with hematologic malignancies, according to results of a prospective study published in Blood.

Additionally, grip strength could predict survival among patients who are unable to walk, researchers noted.

“The slower someone walks, the higher their risk for problems,” Jane A. Driver, MD, MPH, co-director of the Older Adult Hematologic Malignancy Program at Dana-Farber Cancer Institute and associate director of geriatric research education and clinical center at VA Boston Healthcare System, said in a press release. “There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes.”

Driver and colleagues analyzed 448 patients aged 75 years and older (mean age, 79.7 years; 65.2% men) presenting for an initial consultation at hematology clinics affiliated with Dana-Farber Cancer Institute who agreed to have their walking speed and grip strength tested by researchers.

Patients unable to walk (n = 31) had a gait speed recorded as zero.

A majority of patients (62.5%) had an aggressive form of cancer. The most common malignancies included plasma cell neoplasms (30.6%), non-Hodgkin lymphoma (28.6%) and myeloid neoplasms (17.6%).

Investigators measured walking speed using the NIH 4-meter gait speed test, in which patients walked 4 meters at a normal pace and their speed was recorded with a stopwatch.

Results showed that after adjustment for age, cancer type and other factors, every 0.1-meter-per-second decrease in walking speed appeared associated with a higher mortality (HR = 1.22; 95% CI, 1.15-1.3), higher odds of unplanned hospitalizations (OR = 1.33; 95% CI, 1.16-1.51) and higher odds of ED visits (OR = 1.34; 95% CI, 1.17-1.53).

The association between adjusted walking speed and survival outcomes appeared strongest among patients with non-Hodgkin lymphoma (HR = 1.53; 95% CI, 1.25-1.89), followed by patients with other malignancies (HR = 1.38; 95% CI, 1.08-1.75), plasma cell neoplasms (HR = 1.24; 95% CI, 1.03-1.49) and acute myeloid leukemia (HR = 1.21; 95% CI, 1.04-1.41).

Every 5-kg decrease in grip strength appeared associated with worse survival (adjusted HR = 1.24; 95% CI, 1.07-1.43); however, this measure did not affect hospital stays or visits to the ED.

Researchers acknowledged study limitations, including use of data from a single institution and early deaths unrelated to the study.

“Our study reveals that the current standard of care for functional assessment in oncology — performance status — is not sufficient for elders with blood cancers,” Gregory A. Abel, MD, MPH, co-director of the Older Adult Hematologic Malignancy Program at Dana-Farber Cancer Institute, said in a press release. “Gait speed appears to be much better at differentiating those patients at highest risk for poor outcomes.” – by John DeRosier

Disclosures: The authors report no relevant financial disclosures.