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Gait Speed Identifies Frailty, Could Help Predict Outcomes in Older Patients With Hematologic Cancers

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Key Points

  • For every 0.1 meter per second decrease in walking speed, the risk of dying or unplanned hospital or emergency room use increased by 22%, 33%, and 34%, respectively.
  • The association between slower walking speed and poorer outcomes persisted even after adjusting for cancer type, whether the disease was aggressive or indolent, age, and other demographic factors, as well as traditional measures of frailty and functional status.
  • Gait speed remained an independent predictor of death even after accounting for standard physician-reported performance status.

The speed at which older individuals with blood cancers are able to walk 4 meters (about 13 feet) holds information about their overall health and may help to predict survival and unplanned hospital visits, according to study published by Liu et al in Blood. The association was strongest in patients with non-Hodgkin lymphoma.

The study data show that for every 0.1 meter per second decrease in walking speed, the risk of dying or unplanned hospital or emergency room use increased by 22%, 33%, and 34%, respectively.

“The slower someone walks, the higher their risk of problems,” said senior study author Jane A. Driver, MD, MPH, Associate Director of the Geriatric Research Education and Clinical Center at VA Boston Health-care System, Co-Director of the Dana Farber Older Adult Hematologic Malignancy Program, in a press release.

Researchers said these results support efforts to integrate gait speed as a routine part of medical assessments for older patients with blood cancer, and that gait speed should be measured over time to guide treatment plans.

“There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes. This test can be done in less than a minute and takes no longer than measuring blood pressure or other vital signs,” said Dr. Driver. “Based on our findings, it is as good as other commonly used methods which take considerably more time and resources and may not be practical for many oncology clinics.”

Methods

This prospective study enrolled a total of 448 adults with hematologic cancers aged 75 years and older who had an initial consultation for cancer treatment at hematology clinics affiliated with Dana-Farber Cancer Institute between February 2015 and October 2017. Participants were 79.7 years old on average, and completed several screenings for cognition, frailty, gait, and grip strength. Gait speed was obtained using the National Institutes of Health 4-m gait speed test. Patients were asked to walk at a normal pace for 4 meters, and their speed was recorded in meters per second using a stopwatch.

Additional Findings

The association between slower walking speed and poorer outcomes persisted even after adjusting for cancer type, whether the disease was aggressive or indolent, age, and other demographic factors, as well as traditional measures of frailty and functional status. Gait speed remained an independent predictor of death even after accounting for standard physician-reported performance status.

In addition, among patients with very good or excellent physician-reported performance status, patients were stratified into three groups by gait speed—those at risk or frail, prefrail, or robust. A subset of 314 patients were followed for an average of 13.8 months. Of these, nearly 20% had an unplanned hospital stay unrelated to elective or scheduled treatments, and 16.8% visited the emergency department.

“Our study shows that performance status alone may not be good enough. Gait speed appears to be much better at differentiating patients who are at high risk,” explained Dr. Driver. “The standard of care is to stratify treatments based on patients’ performance status, and while this works well in younger people, these results show that in older people, we need to do more.”

Dr. Driver said these results suggest gait speed should also be incorporated into predictive models to assess how older patients with cancer will fare. Measuring gait speed doesn’t require special equipment, is reasonably efficient, and has value even for patients who use a cane or a walker, she added.

The authors also assessed grip strength in all patients; although it strongly predicted survival, it did not predict hospitalization or emergency room use as well as gait speed.

Disclosure: For full disclosures of the study authors, visit bloodjournal.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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