Virtual frailty assessment in older adults with blood cancers

ABSTRACT

Background: Frailty and geriatric assessments (GA) in oncology practice remain limited, and the COVID-19 pandemic has reduced the number of in-person visits. We aimed to develop and validate a virtual frailty assessment that incorporates both patient-reported and objective performance measures. Methods: The Older Adult Hematologic Malignancies Program at Dana-Farber is a clinical and research collaboration between geriatricians and oncologists. We have conducted screening GAs in over 800 patients since 2015. From this GA, we assess frailty via the phenotypic and deficit accumulation approaches based on 42 health deficits spanning the domains of function, mobility, comorbidity, and cognition. We adapted the measurement of these deficits to a virtual format, delivered through either videoconference or telephone. Patient-reported items were readily converted to the virtual format. Of the objective performance measures (7), grip strength was replaced with self-reported grip strength. The Clock-in-the-Box test was changed to a simple clock draw that the patient completes on a piece of paper and displays to the camera for scoring. Four-meter gait speed is collected by training a caregiver to administer with a stopwatch and a 4-meter strip of ribbon (mailed to patients). Geriatricians (C.D., T.H., and J.D.) and an oncologist (G.A.) reviewed the virtual GA for content validity. Feasibility will be measured as the proportion of patients who agree to participate and complete the virtual assessment. For reliability, two virtual frailty indices will be measured one week apart and compared. For agreement, the virtual frailty index will be compared against formerly collected in-person frailty indices from age-and gender-matched patients. In a subset of patients, the validity and reliability of virtual gait speed will be assessed by comparing our virtual tests administered in-home by the caregiver with in-person tests administered in-clinic by our research team. Results: Currently enrolling. Conclusions: A virtual frailty assessment that is valid and reliable will expand the delivery of the GA to older adults with blood cancers during and after the pandemic.