Walking speed predicts clinical outcome in elderly people with blood cancer

How fast – or fast – older people with blood cancer can walk four meters contain essential information about their overall health and can predict with certainty survival and unplanned visits to the hospital, regardless age, type of treatment or type of treatment, according to a new study published today in Some blood. The badociation was strongest in people with non-Hodgkin's lymphoma.

In fact, the data show that for each 0.1-meter-per-second decrease in walking speed, the risk of dying, unexpectedly going to the hospital, or being in an emergency increases by 22%, 33% and 34%, respectively.

"The slower a person walks, the greater their risk of problems," said Jane A. Driver, MD, MPH, Associate Director of the Geriatric Research Training Center and VA Boston Health System Clinical Center and Dana Co-Director. Farber Older Adult Hematologic Cancer Research Program and lead author of the study.

Monitoring the speed of walking not only helps to recognize frail people and perhaps less well, but it also identifies people in better shape than expected by their mere age. The researchers say these findings support efforts to incorporate gait speed into the medical badessments of elderly patients with blood cancer, and that this measure should be measured over time to guide treatment plans.

"There is an unmet need for brief brittle screening tests that can easily be incorporated into the clinical workflow and can predict clinical outcomes." This test can be performed in less than one year. minute and does not take longer than blood pressure or other vital signs "Driver. "Based on our findings, this method is as effective as other commonly used methods, which take a lot more time and resources and may not be practical for many oncology clinics."

This prospective study included a total of 448 adults with hematologic malignancies aged 75 years and older who received an initial consultation for cancer treatment in hematology clinics affiliated with the Institute of Cancer Dana-Farber in Boston between February 1, 2015 and October 31, 2017. Participants were 79.7 years old on average and each tested for their cognition, fragility, gait and grip strength. The walking speed was obtained using the National Institutes of Health's 4-meter walking speed test. Patients were asked to walk at a normal pace over 4 meters and their speed was recorded in meters per second using a stopwatch.

The badociation between a slower gait speed and poorer results persisted even after adjusting for the type of cancer, whether it is an aggressive or indolent illness, the 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 taking into account the standard performance status reported by the physician. In addition, among the patients with a very good or excellent performance index reported by the physician, the patients were stratified into three groups according to the speed of walking: 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% had an unplanned hospital stay, no link to elective or scheduled treatment, and 16.8% visited the emergency department.

"Our study shows that performance status alone may not be enough – the speed of walking seems to be much more effective in differentiating high-risk patients," explained Driver. "The standard of care is to stratify treatments according to the patient's performance status.While it works well in younger people, these results show that, in older people, we need to do more . "

Walking may seem simple, but it is quite complex, since multiple body systems, including the musculoskeletal, cardiovascular and nervous systems, must function properly together. Walking speed has been widely used as an badessment in rehabilitation medicine and geriatrics. According to the driver, these results suggest incorporating gait speed into predictive models to badess the fate of elderly cancer patients. Measuring walking speed does not require any special equipment, is reasonably effective and valid even for patients who use a cane or a walker, she added.

The authors also badessed the grip strength in all patients, although it strongly predicted survival, nor did it predict hospitalization or use of emergency rooms, nor the speed of walking.

Previous studies had shown that frailty was common in patients with blood cancers and was related to chemotherapy-related toxicity, poorer treatment response, and even death. Although the results of this study are limited to one facility, Driver explained that they demonstrated the feasibility of using gait speed to badess the fragility and overall prognosis of cancer patients some blood.