Contributions
Abstract: PB2198
Type: Publication Only
Background
The International Myeloma Working Group (IMWG) has defined a frailty score (GA scale) based on comorbidity index, Charlson score and Katz basic activities of daily living scale for elderly myeloma patients. This score has demonstrated to be more sensitive for geriatric assessment and aids in choosing the most appropriate treatment for each patient. Although GA scale calculation is defined as easy, fast and effective, it is sometimes difficult, due to time constraints, to perform it during the pre-treatment visit. For this reason, the therapeutic decision is still often based on clinical judgment.
Aims
To compute the concordance between clinical judgment and GA scale.
In discordant cases, to investigate whether the therapeutic decision has been adequate, assessing toxicity, tolerance and treatment discontinuation.
Methods
From 2015 to 2017, 47 evaluations in 43 patients were performed. The clinical judgment was established during the clinical visit considering age, ECOG, family support and cognitive evaluation and patients were classified as Fit, Unfit and Frail. The GA scale was calculated by the case manager before or during the first cycle of treatment except for 3 patients who did not finally receive treatment. Discordant cases were revised according to the clinical follow up. We defined as undervalued and overvalued, patients with a clinical judgment lower or greater than GA scale respectively.
Results
Twenty-five evaluations were done in patients between 65-75 years and 22 in patients > 75 years. Discordant results have been found in 21/47 cases (44%) with a low concordance (Kappa= 0,338). Eleven cases were undervalued and 10 cases were overvalued.
The treatment was discontinued in 3/11 (27%) cases of the undervalued group and 2/10 (20%) cases of the overvalued group. In both groups, toxicity was the main cause of treatment discontinuation. There were no treatment related deaths.
There were no significant differences in number of discrepancies between age groups (p=0.96).
Conclusion
A low concordance between clinical judgment and GA scale was observed (Kappa=0.338).For discordant cases, discrepancies that led to treatment discontinuation were observed in more than 20% of the cases (20% in overvalued group and 27% in the undervalued group).
Both the low concordance observed and the amount of significant discrepancies demonstrate once again that the application of the GA scale in elderly patients is more sensitive than the clinical assessment to establish the most appropriate treatment.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Elderly, Multiple Myeloma, toxicity, Treatment
Abstract: PB2198
Type: Publication Only
Background
The International Myeloma Working Group (IMWG) has defined a frailty score (GA scale) based on comorbidity index, Charlson score and Katz basic activities of daily living scale for elderly myeloma patients. This score has demonstrated to be more sensitive for geriatric assessment and aids in choosing the most appropriate treatment for each patient. Although GA scale calculation is defined as easy, fast and effective, it is sometimes difficult, due to time constraints, to perform it during the pre-treatment visit. For this reason, the therapeutic decision is still often based on clinical judgment.
Aims
To compute the concordance between clinical judgment and GA scale.
In discordant cases, to investigate whether the therapeutic decision has been adequate, assessing toxicity, tolerance and treatment discontinuation.
Methods
From 2015 to 2017, 47 evaluations in 43 patients were performed. The clinical judgment was established during the clinical visit considering age, ECOG, family support and cognitive evaluation and patients were classified as Fit, Unfit and Frail. The GA scale was calculated by the case manager before or during the first cycle of treatment except for 3 patients who did not finally receive treatment. Discordant cases were revised according to the clinical follow up. We defined as undervalued and overvalued, patients with a clinical judgment lower or greater than GA scale respectively.
Results
Twenty-five evaluations were done in patients between 65-75 years and 22 in patients > 75 years. Discordant results have been found in 21/47 cases (44%) with a low concordance (Kappa= 0,338). Eleven cases were undervalued and 10 cases were overvalued.
The treatment was discontinued in 3/11 (27%) cases of the undervalued group and 2/10 (20%) cases of the overvalued group. In both groups, toxicity was the main cause of treatment discontinuation. There were no treatment related deaths.
There were no significant differences in number of discrepancies between age groups (p=0.96).
Conclusion
A low concordance between clinical judgment and GA scale was observed (Kappa=0.338).For discordant cases, discrepancies that led to treatment discontinuation were observed in more than 20% of the cases (20% in overvalued group and 27% in the undervalued group).
Both the low concordance observed and the amount of significant discrepancies demonstrate once again that the application of the GA scale in elderly patients is more sensitive than the clinical assessment to establish the most appropriate treatment.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Elderly, Multiple Myeloma, toxicity, Treatment