Prevalence and impact of frailty assessed using standard geriatrics tools in older adults with blood cancers

Abstract

Geriatric assessment is recommended for older adults undergoing cancer treatment, but the best frailty assessment tools for blood cancers are unknown. We conducted a prospective cohort study of three gold standard approaches: the cumulative deficit index, phenotypic frailty, and four-meter gait speed. From February 2015 to January 2025, a research assistant approached patients aged ≥ 73 years attending new consultations for leukemia, lymphoma, and multiple myeloma. A total of 1011 patients underwent frailty assessment with a median age of 78 years (IQR, 76-82 years) and a median follow-up among survivors of 43 months (IQR, 18-74 months). For example, when classified by phenotypic frailty, 11% were frail, 59% pre-frail, and 30% robust; using this tool, frail patients lived 24 months compared to 92 months among the robust. While frailty classification varied across measures, all three tools were associated with mortality in a dose-dependent manner, independent of age and sex (cumulative deficit index: ref=robust, pre-frail HR 1.86 [95% CI 1.54, 2.26]; frail HR 2.42 [1.85, 3.17]; phenotypic frailty: ref=robust; pre-frail HR 1.88 [1.50, 2.37], frail HR 3.01, [2.22, 4.07]); gait speed: ref=≥ 0.8 m/s; 0.6 to < 0.8 m/s HR 1.44 [1.18, 1.76], < 0.6 m/s HR 2.06 [1.61, 2.63]). Associations were similar when analyzed by disease clinic; cumulative deficit further stratified risk in patients assessed by phenotypic frailty and gait speed. Our findings provide a new benchmark on frailty and its impact on survival in older adults with blood cancers, with care delivery implications for operationalization in clinical practice and research.