New Virtual Frailty Assessments Seek to Standardize Performance Measures for Older Adults With Blood Cancer

Sap Partners | Cancer Centers | <b>Dana-Farber Cancer Institute</b>

Investigators at Dana-Farber Cancer Institute are developing a virtual frailty assessment, which combines both patient-reported outcomes and standardized performance measures.

New findings suggest that virtual frailty assessments are both safe and feasible for older adults with blood cancers; however, investigators note that they may be less sensitive to severe cases of severe frailty compared with in-person assessments, according to a study published in Blood Advances.

Geriatric and frailty assessments are recommended for all older adults undergoing systemic treatment for cancer. However, the COVID-19 pandemic has brought into question the feasibility of depending on in-person appointments and has highlighted the need for alternative appointment style options. Videoconferences or telephone visits have represented a potential solution to these challenges, but analyses regarding the feasibility of these assessments are largely insufficient. Moreover, to date, most virtual assessments consist of patient-reported measures without objective performance measures such as standardized tests of mobility and cognition—measures which have demonstrated predictive value in this setting.

In light of this, investigators sought to test a virtual frailty assessment which combine both patients-reported outcomes and standardized assessments.

The observational study assessed the feasibility of these reports for patients with blood cancer who were transplant ineligible and who were enrolled in the Older Adult Hematology Malignancies Program at Dana-Farber Cancer Institute in Boston, Massachusetts. Patients were divided into 2 cohorts based on the type of visit: in-person (age ≥ 75 years) or via telehealth (age ≥ 73 years).

Patients who were seen in-person were given a geriatric screening by a research assistant on the same day as their initial hematologic oncology consultation. The geriatric assessment inquired about patient-reported and objective measures, including comorbidity, functional status, physical performance, and cognition.

The study included 185 virtual patients after reaching out to 254 eligible patients. Of the 185 participants, 150 (81%) completed the virtual assessment. The in-person cohort included 876 patients out of 1017 possible recruits. Baseline assessments were consistent across the 2 groups, although a slightly lower proportion of pre-frail and frail patients were calculated in the group of virtual patients. Frailty measures included overall frailty status, frailty phenotype, and frailty by deficit accumulation.

Overall, the virtual assessments demonstrated a trend toward lower likelihood of identifying patients as frail by the phenotypic approach (odds ratios [OR], 0.66; 95% CI, 0.45-0.98), and as frail by the deficit accumulation approach (OR, 0.75; 95% CI, 0.51-1.11). Of note, the investigators identified weakened associations among patients depending on age, gender, disease type, and ECOG performance status, suggesting that differences in populations completing each assessment type may be linked to the findings rather than the assessments themselves.

“Even if our virtual frailty assessment is less sensitive at detecting frailty, the degree of reduced sensitivity is small and must be balanced against the increased burden and risk of in-person assessments,” the study authors wrote. “In our example, our virtual frailty assessment allowed our research and clinical program for older adults with blood cancers to continue through several waves of the pandemic and could allow for decentralization of assessments beyond the pandemic to potentially reach more older adults with blood cancers.”

Reference

DuMontier C, Jaung T, Bahl NE, et al. Virtual frailty assessment for older adults with hematologic malignancies. Blood Adv. Published online May 26, 2022. doi:10.1182/bloodadvances.2022007188