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Gait speed, grip strength and clinical outcomes in older patients with hematologic malignancies

Michael A Liu, Clark DuMontier, Anays Murillo, Tammy Hshieh, Jonathan F Bean, Robert J Soiffer, Richard M Stone, Gregory A Abel and Jane A Driver

Key Points

  • Gait speed is a marker of frailty and can independently predict survival and hospital utilization among older patients with blood cancers.

  • Assessing gait speed in oncology clinics may substantially improve patient assessment, prognostication, and individualization of care.

Abstract

This study aims to evaluate if gait speed and grip strength are useful predictors of clinical outcomes among older adults with blood cancers. We prospectively recruited 448 patients aged 75 and older presenting for initial consultation at the MDS/leukemia, myeloma, or lymphoma clinics of a large tertiary hospital, who agreed to assessment of gait and grip. A subset of 314 patients followed for at least 6 months at local institutions was evaluated for unplanned hospital or emergency department (ED) use. Cox proportional hazards models calculated hazard ratios (HR) and 95% confidence intervals (95% CI) for survival, and logistic regression to calculate odds ratios (OR) for hospital or ED use. Mean age was 79.7 ({plus minus}4.0 SD) years. After adjustment for age, sex, Charlson comorbidity index (CCI), cognition, treatment intensity, and cancer aggressiveness/type, every 0.1 m/s decrease in gait speed was associated with higher mortality (HR=1.22; 95% CI:1.15-1.30), odds of unplanned hospitalizations (OR 1.33; 95% CI 1.16-1.51) and ED visits (OR 1.34; 95% CI 1.17-1.53). Associations held among patients with good ECOG performance status (0 or 1). Every 5 kg decrease in grip strength was associated with worse survival (adjusted HR =1.24; 95% CI: 1.07-1.43), but not hospital or ED use. A model with gait speed and all covariates had comparable predictive power to comprehensive, validated frailty indexes (phenotype and cumulative deficit) and all covariates. In summary, gait speed is an easily obtained "vital sign" that accurately identifies frailty and predicts outcomes independent of performance status among older patients with blood cancers.

  • Submitted January 14, 2019.
  • Revision received April 18, 2019.
  • Accepted April 18, 2019.