Dana-Farber Study Finds Frailty Strongly Predicts Survival in Older Adults with Blood Cancers

In one of the largest studies of its kind, researchers at Dana-Farber Cancer Institute found that frailty is common among older adults with blood cancers and strongly predicts survival, independent of age. The findings, based on more than 1,000 patients evaluated through Dana-Farber’s Older Adult Hematologic Malignancies (OHM) Program over 10 years, suggest that frailty assessment should play a central role in treatment planning and supportive care for older patients with leukemia, lymphoma, and multiple myeloma.

Older adults make up most patients with blood cancers, but they are often underrepresented in clinical trials of new therapies. To help address that gap, hematologic oncologists and geriatricians at Dana-Farber launched the Older Adult Hematologic Malignancies, or OHM, Program in 2015 to bring geriatric assessment into routine cancer care. Since then, the program has evaluated more than 1,000 older patients, providing a detailed look at how aging-related health issues affect outcomes.

The study, published in Haematologica, used three established geriatric tools to assess frailty, or how resilient a person is to the stresses caused by cancer, its treatment or other non-cancer-related diagnoses. The researchers examined a comprehensive cumulative deficit frailty index, a phenotypic frailty model based on signs such as weakness and weight loss, and a simple four-meter walking-speed test. Across all three approaches, patients who were frail or even pre-frail had a significantly higher risk of death than those who were robust.

“Although numerous tools in oncology are described as measures of frailty, many assess only fragments of the construct,” said Clark DuMontier, MD, first author of the study and co-director of the Older Adult Hematologic Malignancies Program. “Our study used well validated geriatric approaches that comprehensively assess health deficits with the goal of optimizing treatment decisions and supportive care for older adults with blood cancers.”

The median age of patients in the study was 78, and survivors were followed for a median of 43 months. Using the phenotypic frailty model, 11% of patients were classified as frail, 59% as pre-frail, and 30% as robust. Median survival was 24 months for frail patients, compared with 92 months for robust patients. Using the cumulative deficit index, 10% were frail, 33% pre-frail, and 57% robust; frail patients had a median survival of 26 months, compared with 75 months for robust patients.

Even brief measures were highly informative. Patients with the slowest walking speeds had about twice the risk of death as those in the fastest group, showing that a simple walking test can reveal important information about a patient’s overall physiologic reserve. Single-item questions, such as how many days a week a patient walks outside, also showed promise in identifying vulnerable patients.

These findings are important because standard oncology measures do not fully capture this vulnerability. About 90% of patients rated themselves as having a relatively good performance status (using the historic ECOG scale), yet 40-70% were classified as pre-frail or frail by the geriatric tools used in the study. The researchers also found that while all three frailty tools predicted survival, they did not always classify the same patients in the same way. In particular, the more detailed cumulative deficit index further separated risk among some patients labeled pre-frail by shorter methods.

“Since launching the Older Adult Hematologic Malignancies Program in 2015, we’ve shown that frailty is both common and a powerful predictor of survival in older adults,” said Gregory Abel, MD, MPH, senior author of the study and Director of the Older Adult Hematologic Malignancies Program.

Frailty-guided care is already recommended in national oncology guidelines, and these findings show how it can be applied in blood cancers. The researchers say detailed assessments can identify problems in function, cognition, nutrition, and mobility, while shorter tools can help busy clinics flag higher-risk patients. They also emphasize that recognizing frailty is only the first step toward tailoring treatment and support and avoiding both overtreatment and undertreatment.

Funding was provided by the American Cancer Society DBG-24-1188416-01-CTPS (to CD and GAA), American Society of Clinical Oncology/Walther Cancer Foundation Career Development Award (to CD), and the Mary P. Murphy Fund for Hematologic Malignancies (to GAA).