New Tool for Assessing Frailty Predicts Survival in Newly Diagnosed Multiple Myeloma

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A new frailty index predicts overall survival for patients newly diagnosed with multiple myeloma, according to a study recently published in JCO Clinical Cancer Informatics (JCO CCI). This tool is important because frailty is a critical factor in treatment decision-making for many patients with multiple myeloma, as the cancer most commonly arises among older adults. 

As many as 35% to 40% of patients with multiple myeloma are aged 75 or older. While new therapies and better supportive care have significantly improved outcomes, an ongoing challenge is distinguishing patients who can safely undergo these aggressive treatments from more frail patients who would benefit more from less aggressive approaches that preserve their overall health and quality of life.

In this federally funded study, researchers analyzed data from 2,692,361 noncancer patients over the age of 66 in Medicare Health Outcomes Survey (MHOS) and the Surveillance, Epidemiology, and End Results (SEER)-MHOS linked databases between 1998 and 2009.

Using these data, the authors created a deficit accumulation frailty index (DAFI) made up of a 25-item scale and scoring system. The index includes criteria in five categories for scoring frailty: activities of daily living (eg, difficulty dressing or eating); chronic health conditions; functioning (eg, difficulty walking or climbing several sets of stairs); general health; and mental health. Patients whose scores exceed a certain threshold on the scale are classified as frail.

The index then was applied to 305 patients with newly diagnosed myeloma in the SEER-MHOS database to predict overall survival. In applying the frailty index to people newly diagnosed with multiple myeloma and patients without cancer, the researchers found:

  • For patients with multiple myeloma, age was weakly correlated with a higher frailty score, yet for noncancer patients, an increase in age was strongly correlated with a higher frailty score.
  • Overall, 42% of noncancer patients were considered frail compared to 52% of the patients with multiple myeloma.
  • The median overall survival of patients who were considered frail was 26.8 months compared to the nonfrail cohort, where overall survival was 43.7 months.
  • Among noncancer patients, each 10% increase in frailty index score was associated with a 40% increased risk for death.
  • Among the patients with multiple myeloma, each 10% increase in the frailty index score was associated with a 16% increased risk of death.

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© 2018. American Society of Clinical Oncology. All rights reserved.