Clark DuMontier1,2,3, Michael A Liu2,4, Anays Murillo5, Tammy Hshieh4,6, Houman Javedan4, Robert Soiffer6, Richard M Stone6, Jane A Driver3,4,6, Gregory A Abel5,6. 1. Division of Gerontology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. 2. Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 3. Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts. 4. Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts. 5. Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts. 6. Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
Abstract
BACKGROUND/ OBJECTIVES: Cancer-focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute-care utilization in populations of older adults with different hematologic malignancies. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A screening geriatric assessment was conducted for adults 75 years and older with hematologic malignancies (n = 464) presenting for initial consultation at a large tertiary cancer hospital in Boston, MA. MEASUREMENTS: Univariable and multivariable analyses assessed the association of dependency in ADLs and dependency in iADLs with survival and care utilization (emergency department [ED] visits and unplanned hospitalizations). RESULTS: Subjects were a mean age of 79.7 years and had a mean follow-up of 13.8 months. Overall, 11.4% had dependency in ADLs and 26.7% had dependency in iADLs. Only iADL dependency was associated with higher mortality (hazard ratio = 2.34 [95% confidence interval [CI] = 1.46-3.74]) independently of age, comorbidity, cancer aggressiveness, and treatment intensity. The effect was dose dependent, and impairments in shopping, meal preparation, and housework were all independently associated with a higher hazard of death. iADL dependency was also associated with higher odds of ED visits (odds ratio [OR] = 2.76 [95% CI = 1.30-5.84]) and hospitalizations (OR = 2.89 [95% CI = 1.37-6.09]). Several geriatric domain impairments, including probable cognitive impairment and physical dysfunction, were associated with iADL dependency. CONCLUSION: These findings suggest that older adults with hematologic malignancies and iADL dependency experience higher mortality and acute-care utilization, arguing that iADLs should be formally assessed as part of routine oncology care. J Am Geriatr Soc 67:889-897, 2019.
BACKGROUND/ OBJECTIVES:Cancer-focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute-care utilization in populations of older adults with different hematologic malignancies. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A screening geriatric assessment was conducted for adults 75 years and older with hematologic malignancies (n = 464) presenting for initial consultation at a large tertiary cancer hospital in Boston, MA. MEASUREMENTS: Univariable and multivariable analyses assessed the association of dependency in ADLs and dependency in iADLs with survival and care utilization (emergency department [ED] visits and unplanned hospitalizations). RESULTS: Subjects were a mean age of 79.7 years and had a mean follow-up of 13.8 months. Overall, 11.4% had dependency in ADLs and 26.7% had dependency in iADLs. Only iADL dependency was associated with higher mortality (hazard ratio = 2.34 [95% confidence interval [CI] = 1.46-3.74]) independently of age, comorbidity, cancer aggressiveness, and treatment intensity. The effect was dose dependent, and impairments in shopping, meal preparation, and housework were all independently associated with a higher hazard of death. iADL dependency was also associated with higher odds of ED visits (odds ratio [OR] = 2.76 [95% CI = 1.30-5.84]) and hospitalizations (OR = 2.89 [95% CI = 1.37-6.09]). Several geriatric domain impairments, including probable cognitive impairment and physical dysfunction, were associated with iADL dependency. CONCLUSION: These findings suggest that older adults with hematologic malignancies and iADL dependency experience higher mortality and acute-care utilization, arguing that iADLs should be formally assessed as part of routine oncology care. J Am Geriatr Soc 67:889-897, 2019.
Authors: Maria Queralt Salas; Eshetu G Atenafu; Ora Bascom; Leeann Wilson; Wilson Lam; Arjun Datt Law; Ivan Pasic; Dennis Dong Hwan Kim; Fotios V Michelis; Zeyad Al-Shaibani; Armin Gerbitz; Auro Viswabandya; Jeffrey Howard Lipton; Jonas Mattsson; Shabbir M H Alibhai; Rajat Kumar Journal: Bone Marrow Transplant Date: 2020-06-30 Impact factor: 5.483
Authors: Clark DuMontier; Mina S Sedrak; Wee Kheng Soo; Cindy Kenis; Grant R Williams; Kristen Haase; Magnus Harneshaug; Hira Mian; Kah Poh Loh; Siri Rostoft; William Dale; Harvey Jay Cohen Journal: J Geriatr Oncol Date: 2019-08-23 Impact factor: 3.599
Authors: Clark DuMontier; Hajime Uno; Tammy Hshieh; Guohai Zhou; Richard Chen; Emily S Magnavita; Lee Mozessohn; Houman Javedan; Richard M Stone; Robert J Soiffer; Jane A Driver; Gregory A Abel Journal: Haematologica Date: 2022-05-01 Impact factor: 11.047
Authors: Mikkael A Sekeres; Gordon Guyatt; Gregory Abel; Shabbir Alibhai; Jessica K Altman; Rena Buckstein; Hannah Choe; Pinkal Desai; Harry Erba; Christopher S Hourigan; Thomas W LeBlanc; Mark Litzow; Janet MacEachern; Laura C Michaelis; Sudipto Mukherjee; Kristen O'Dwyer; Ashley Rosko; Richard Stone; Arnav Agarwal; L E Colunga-Lozano; Yaping Chang; QiuKui Hao; Romina Brignardello-Petersen Journal: Blood Adv Date: 2020-08-11
Authors: Heidi D Klepin; Can-Lan Sun; David D Smith; Rawad Elias; Kelly M Trevino; Ashley Leak Bryant; Daneng Li; Christian Nelson; William P Tew; Supriya G Mohile; Ajeet Gajra; Cynthia Owusu; Cary Gross; Stuart M Lichtman; Vani V Katheria; Hyman B Muss; Andrew E Chapman; Harvey Jay Cohen; Arti Hurria; William Dale Journal: JCO Oncol Pract Date: 2021-04-21
Authors: Kah Poh Loh; Vivian Lam; Katey Webber; Simran Padam; Mina S Sedrak; Vivek Musinipally; Madison Grogan; Carolyn J Presley; Janice Grandi; Chandrika Sanapala; Daniel A Castillo; Grace DiGiovanni; Supriya G Mohile; Louise C Walter; Melisa L Wong Journal: J Natl Compr Canc Netw Date: 2021-04-15 Impact factor: 12.693