Malnutrition in Older Patients With Hematological Malignancies at Initial Diagnosis - Association With Impairments in Health Status, Systemic Inflammation and Adverse Outcome.

Poor nutritional status is a common problem in cancer patients at advanced age, but the prevalence and impact of malnutrition in hematological malignancies remains underinvestigated. To evaluate nutritional status in older adults over age 70 with newly diagnosed hematological malignancies, we enrolled 147 patients and assessed weight loss, food intake, Mini Nutritional Assessment (MNA), and BMI. We compared nutritional status with demographic data, inflammation markers, and restrictions in multidimensional geriatric assessment. MNA classified 43% of patients being at risk of, and 15% having manifest malnutrition. A moderate/severe decrease in food intake was reported by 24% or 16%, a recent weight loss of 1 to 3 kg or >3 kg by 19% or 31%, and a BMI <23 kg/m2 by 29%. Lowered serum albumin (<3.5 g/dL) was prevalent in 14% of patients, and in 38% Glasgow Prognostic Score indicated hyperinflammation. Principal component analysis clustered malnutrition with inflammation markers and pronounced impairments, that is, fatigue, depression, comorbidities, reduced functional capacities. Severe decrease in food intake (HR: 3.3 (1.9-5.8), p < 0.001), >3 kg weight loss (HR: 2.3 (1.4-3.9), p = 0.001), impaired MNA (HR: 2.8 (1.3-6.2), p = 0.010), and low serum albumin (HR: 2.1 (1.1-4.0), p = 0.030) were significantly associated with shortened overall survival. Recent weight loss >3 kg (HR: 2.2 (1.1-4.3), p = 0.022), and low BMI (HR: 3.3 (1.8-6.0), p < 0.001) remained independent adverse parameters in multivariate Cox proportional hazard regression analyses. Malnourishment at initial diagnosis is frequent in older patients with hematological malignancies and represents an adverse prognosticator. Clustering of malnutrition with impairments and systemic inflammation suggests an underlying common pathway.

PPT and VES-13 in elderly patients with cancer: evaluation in multidimensional geriatric assessment and prediction of survival.

OBJECTIVES: The multidimensional geriatric assessment (MGA) detects impairments in the elderly and forms the basis for individualized treatment algorithms. Screening tools have been developed to detect patients in need of a full assessment. The aim of this pilot study was to evaluate the discriminative power and the prognostic impact of the screening scores for the Physical Performance Test (PPT) and the Vulnerable Elders Survey-13 (VES-13). MATERIALS AND METHODS: In 77 patients with cancer aged ≥60years (median 74years) from the Department of Internal Medicine V, Innsbruck Medical University, VES-13 and PPT were performed and compared with data from MGA and clinical outcomes. RESULTS: Overall, of the 77 patients 70% was deemed impaired, as defined by impairments in two or more scores of the MGA. The VES-13 showed 42% to be impaired, the PPT 79%. Using a cut-off of ≤19, the PPT exhibited better discriminative power than did the standard PPT (≤20). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of VES-13, PPT≤20 and PPT≤19 in the detection of impairments were 56% (88%, 82%), 91% (45%, 75%), 94% (80%, 89%), and 45% (60%, 63%) respectively. The area under the curve was 0.73 (0.67, 0.79), respectively. Both impaired VES-13 and PPT significantly correlated with an unfavorable overall survival in both uni- and multivariate analysis. CONCLUSION: PPT (≤19) reveals favorable sensitivity, NPV and overall accuracy in elderly patients with cancer. Still, the NPV is too low to sufficiently discriminate between fit and frail patients. Both PPT and VES-13 are useful predictors for survival.