Lymphoma in elderly patients: novel functional assessment techniques provide better discrimination among patients than traditional performance status measures.

BACKGROUND: Age > 60 years and impaired performance status (PS) are adverse prognostic features in the International Prognostic Index for non-Hodgkin's lymphoma; however, patients aged > 60 years compose a heterogeneous population, and commonly used PS measures are subjective and incomplete. PATIENTS AND METHODS: Validated tests are used in geriatric populations to predict mortality and functional decline. The timed "up and go" test measures the time required to stand, walk a set distance, and return. The Tinetti Gait and Balance test measures gait and balance, and the hand grip assesses grip strength. We evaluated these tests in a heterogeneous cohort of older patients with lymphoma, as a first step in identifying prognostic subsets that might differ in the ability to tolerate disease and treatment. The mean age of the patients (N = 25) was 70 years, with 13 men and 12 women. Five patients were newly diagnosed, 15 had aggressive histology, and 10 had indolent disease. Two subjects had Eastern Cooperative Oncology Group PS 0, 20 had PS 1, and 3 had PS 2. Assessments could be conducted in < 5 minutes. Within the largest group (PS 1; n = 20), these tests demonstrated a range of functional status measures.
RESULTS: The interquartile range/median (higher values reflect greater variance) was 73.1 for the handgrip, 42.3 for the "up and go," and 1.8 for the Tinetti test.
CONCLUSION: Accepted geriatric assessment tools can identify subgroups of older patients with lymphoma with distinct functional status. Prospective trials in larger and more homogeneous patient populations will define the potential of these tools to assist in guiding therapy and predicting outcomes.