Virtual frailty exams feasible, safe for older adults with blood cancers
Click Here to Manage Email Alerts
Frailty assessments are important predictors of future health outcomes among geriatric patients with hematologic malignancies.
These assessments, usually performed in clinics, became much more challenging during the COVID-19 pandemic due to the elevated risk for infection that older patients with blood cancers faced. As has been the case in many areas of medicine, this challenge has been met in a manner that will likely endure beyond the pandemic — through telehealth.
Researchers at Brigham and Women’s Hospital and Dana-Farber Cancer Institute focused on the use of virtual examinations among older adults with hematologic malignancies in their observational study published in Blood Advances.
The researchers enrolled 185 patients aged 73 years and older between November 2020 and March 2022 and compared frailty classifications from their virtual assessments with those of 876 patients aged 75 years and older who were assessed in person. They also evaluated the feasibility and safety of the virtual assessment based on how many participants successfully completed the evaluation, and monitored participants for injuries.
Results showed 81.1% of participants completed the test, and none reported injuries during the study.
“Our next step is to leverage what we have learned from our virtual assessments to begin measuring frailty and function not only at baseline, but also longitudinally,” study author Clark DuMontier, MD, MPH, of Brigham and Women’s Hospital, said an interview with Healio. “Our virtual assessments allow us to repeatedly measure frailty in patients without having them come to the clinic, and in doing so, we may be able to earlier detect new or worsening deficits as they arise while a patient progresses with their treatment.”
DuMontier spoke with Healio about the study results and what they might mean for the future of frailty assessments.
Healio: How did the virtual frailty assessment perform vs. traditional, in-person assessments?
DuMontier: The virtual frailty assessments were comparable to in-person assessments. Virtual assessments tended to classify patients to a lower frailty status, but this difference between assessments weakened after adjusting for differences between the patients assessed virtually and the patients assessed in-person related to age, gender, type of malignancy and patient-reported performance status. These findings suggest the observed differences in frailty classification may be due to differences in the populations enrolled, not due to an intrinsic difference between the two approaches.
HealioWhy might home frailty assessments be a more relevant representation of a patient’s daily life?
DuMontier: They may be more accurate than in-person assessment of a patient in clinic given that a patient's fitness and functioning in their home and community is what matters most. Many patients act differently in a clinic setting because they know they are seeing their oncology teams. Their clinic day may be their best day of the week, but in reality they may be spending a lot of time in bed or limited in their activities of daily living. Our virtual frailty assessment can capture these deficits in ways our in-person frailty assessment cannot.
Healio: What are the potential implications of this new way of evaluating frailty among patients with hematologic malignancies?
DuMontier: Because our virtual assessment incorporated both the patient-reported and objective performance measures of our frailty assessment, we were able to continue our clinical and research program through several waves after the pandemic. Moreover, the virtual delivery enhances our ability to “decentralize” our assessments, serving the potential of being incorporated in clinical trials by overcoming barriers related to limited clinic space and staff.
For more information:
Clark DuMontier, MD, MPH, can be reached at Brigham and Women’s Hospital Division of Aging, 1620 Tremont St., Boston, MA 02120; email: cdumontier@bwh.harvard.edu.
Collapse
Click Here to Manage Email Alerts