ABSTRACT
PURPOSE: Older adults with hematologic malignancies (HM) have unique challenges due to age and fitness. The primary aim of this pilot study was to benchmark the ability of multiple biomarkers of aging (p16, epigenetic clocks, T cell gene expression profiles, and T cell receptor excision circles (TREC) to identify frailty as measured by a clinical impairment index (I2) in patients with HM. METHODS: 70 patients newly diagnosed with HM had peripheral blood T lymphocytes (PBTL) analyzed for p16INK4a expression using the OSU_Senescence Nanostring CodeSet. PBTL epigenetic age was measured using 7 epigenetic clocks, and TREC were quantified by qRT-PCR. A composite clinical impairment index (I2) was generated by combining values from 11 geriatric metrics (Independent Activities of Daily Living (iADL), physical health score, Short Physical Performance Battery (SPPB), Body Mass Index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, self-reported KPS, Blessed Orientation Memory Concentration (BOMC), polypharmacy, Mental Health Inventory (MHI)-17, Medical Outcomes Study (MOS) subscales). Clinical frailty was defined as a score of 7 or greater on the I2. RESULTS: Age-adjusted p16INK4a was similar in newly diagnosed patients and healthy controls (p > 0.1). PBTL p16INK4a levels correlated positively with the Hannum [r = 0.35, 95% CI (0.09-0.75); p adj. = 0.04] and PhenoAge [r = 0.37, 95% CI (0.11-0.59); p adj. = 0.04] epigenetic clocks. The discrimination ability of the I2 model was calculated using the area under the receiver operating characteristic curve (AUC). After adjusting for chronologic age and disease group, baseline p16INK4a [AUC = 0.76, 95% CI (0.56-0.98); p = 0.01], Hannum [AUC = 0.70, 95% CI (0.54-0.85); p = 0.01], PhenoAge [AUC = 0.71, 95% CI (0.55-0.86); p = 0.01], and DunedinPACE [AUC = 0.73, 95% CI (0.57-0.88); p = < 0.01] measures showed the greatest potential to identify clinical frailty using the I2. CONCLUSIONS: Our pilot data suggest that multiple blood-based aging biomarkers have potential to identify frailty in older adults with HM. IMPLICATIONS FOR CANCER SURVIVORS: We developed the I2 index to quantify impairments across geriatric domains and discovered that PBTL p16, Hannum, PhenoAge, and DunedinPACE are promising indicators of frailty in HM.
ABSTRACT
Background: While the benefits of bundled transitions of care services are understood, only a limited number of studies have analyzed the impact of a stand-alone bedside medication delivery service on repeat hospital encounters, and those published have reported mixed results. Methods: A retrospective analysis was conducted in medical and surgical patients at a large community hospital. Adult patients discharged from either the cardiology, medicine, pulmonary, orthopedic/spine surgery, or women's surgery unit and prescribed at least one new prescription upon discharge to home between September 2015 and March 2018 were included. The primary objective was to compare unplanned 30-day re-presentation rates in patients who received Meds to Beds services to those who did not. The secondary objective was to compare 30-day re-presentation rates by patient type. Re-presentation was defined as an inpatient admission, emergency department visit, or observational encounter for any diagnosis within the six-hospital health system. Chi-square and logistic regression tests were used to assess statistical significance, and the study was powered to detect a difference in the primary objective. Results: A total of 45,546 patients were included. Of those, 4,286 received Meds to Beds services (Intervention Group, IG) while 41,260 patients did not (Control Group, CG). Overall 30-day re-presentation rate was not statistically different (15% IG versus 15.3% CG, OR 1.0; 95% CI 0.9-1.1; p = 0.76). However, the 30-day re-presentation rate was statistically lower for women's surgery (12.8% IG versus 15.6%, CG p = 0.03, NNT 36) and orthopedics/spine surgery patients (7.3% IG versus 10.2% CG, p < 0.01, NNT 34). Conclusions: While there was no statistically significant differences in overall 30-day re-presentation rates, there were significant reductions in two surgical patient subgroups. Avoidance of re-presentations and generation of prescription revenue outweighed program costs.
