Walking Speed Predicts Clinical Outcomes in Older Adults with Blood Cancers
Slower
walking pace linked to a higher likelihood of death and hospital visits;
Researchers say gait speed should be used along with other vital signs to
better tailor care
Published on: June 05, 2019
(WASHINGTON, June 5, 2019)
— How slow—or fast—older individuals with blood cancers are able to walk four
meters (about 13 feet) holds critical information about their overall health and
strongly predicts survival and unplanned hospital visits regardless of age, cancer
or treatment type, or other factors, according to a new study
published today in Blood. The association was strongest in those with non-Hodgkin
lymphoma.
In fact, data show that
for every 0.1 meter per second decrease in walking speed, the risk of dying,
unexpectedly going to the hospital, or ending up in the emergency room
increased by 22 percent, 33 percent, and 34 percent, respectively.
“The slower someone walks,
the higher their risk of problems,” said Jane A. Driver, MD, MPH, associate
director of the Geriatric Research Education and Clinical Center at VA Boston Healthcare
System, and co-director of the Dana Farber Older Adult Hematologic Malignancy
Program and the study’s senior author.
Monitoring gait speed not
only helps to recognize individuals who are frail and may fare worse, it also
identifies people who are in much better shape than expected based on age
alone. Researchers say these results support efforts to integrate gait speed as
a routine part of medical assessments for older patients with blood cancer, and
it should be measured over time to guide treatment plans.
“There is an unmet need
for brief screening tests for frailty that can easily fit into clinic workflow
and predict important clinical outcomes. This test can be done in less than a
minute and takes no longer than measuring blood pressure or other vital signs,”
said Driver. “Based on our findings, it is as good as other commonly used
methods which take considerably more time and resources and may not be
practical for many oncology clinics.”
This prospective study
enrolled a total of 448 adults with hematologic cancers ages 75 years and older
who had an initial consultation for cancer treatment at hematology clinics
affiliated with Dana-Farber Cancer Institute in Boston between February 1, 2015,
and October 31, 2017. Participants were 79.7 years old on average and each completed
several screenings for cognition, frailty, gait, and grip strength. Gait speed
was obtained using the National Institutes of Health 4-meter gait speed test.
Patients were asked to walk at a normal pace for 4 meters and their speed was
recorded in meters per second using a stopwatch.
The association between slower
walking speed and poorer outcomes persisted even after adjusting for cancer
type, whether the disease was aggressive or indolent, age, and other demographic
factors, as well as traditional measures of frailty and functional status. Gait
speed remained an independent predictor of death even after accounting for
standard physician-reported performance status. In addition, among patients with
very good or excellent physician-reported performance status, patients were
stratified into three groups by gait speed – those at risk or frail, pre-frail,
or robust. A subset of 314 patients were followed for an average of 13.8
months. Of these, nearly 20 percent had an unplanned hospital stay unrelated to
elective or scheduled treatments and 16.8 percent visited the emergency
department.
“Our study shows that performance
status alone may not be good enough. Gait speed appears to be much better at
differentiating patients who are at high risk,” explained Driver. “The standard
of care is to stratify treatments based on patients’ performance status, and
while this works well in younger people, these results show that in older
people we need to do more.”
While walking might seem
simple, it’s quite complex, as multiple bodily systems, including the
musculoskeletal, cardiovascular, and nervous systems, must function properly
together. Gait speed has been widely used as an assessment in rehabilitative
and geriatric medicine. Driver said these results suggest gait speed should
also be incorporated into predictive models to assess how older cancer patients
will fare. Measuring gait speed doesn’t require special equipment, is
reasonably efficient, and has value even for patients who use a cane or a
walker, she added.
The authors also assessed
grip strength in all patients; although it strongly predicted survival, it did
not predict hospitalization or emergency room use as well as gait speed.
Earlier studies have found
that frailty is common among patients with blood cancers and has been linked to
chemotherapy-related toxicity, poorer treatment responses, and even death. While
these study results are limited to a single institution, Driver said they demonstrate
real-world feasibility of using gait speed to gauge frailty and overall prognosis
among patients with blood cancer.
Blood (www.bloodjournal.org),
the most cited peer-reviewed publication in the field of hematology, is
available weekly in print and online. Blood is a journal of the American
Society of Hematology (ASH) (www.hematology.org),
the world’s largest professional society concerned with the causes and
treatment of blood disorders.
ASH’s mission is to
further the understanding, diagnosis, treatment, and prevention of disorders
affecting blood, bone marrow, and the immunologic, hemostatic, and vascular
systems by promoting research, clinical care, education, training, and advocacy
in hematology.
blood® is a registered
trademark of the American Society of Hematology.
Contact:
Amanda
Szabo
American
Society of Hematology
ASzabo@hematology.org
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