Gait Speed May Predict Survival in Older Adults with Hematologic Cancers

A slow walking pace could indicate a higher risk of worsened outcomes for older adults with blood cancers, according to a new study published in Blood.
 
The results of the study suggest that monitoring gait speed could help identify whether older patients with hematologic cancer have a higher risk of morbidity or mortality so that health care providers can better tailor care.
 
For the study, a total of 448 adults with hematologic cancers aged 75 years and older completed several screenings for cognition, frailty, gait, and grip strength. All patients previously had a consultation for cancer treatment at hematology clinics affiliated with Dana-Farber Cancer Institute between February 1, 2015, and October 31, 2017.
 
The researchers used a 4-meter gait speed test from the National Institutes of Health to assess walking pace. For this assessment, patients walked at a normal pace for 4 meters and their speed was recorded in meters per second using a stopwatch.
 
A subset of 314 patients followed for at least 6 months was evaluated for unplanned hospital or emergency department (ED) use. After adjusting for cancer type, disease severity, age, and other demographic factors, every 0.1 m/s decrease in gait speed was associated with a higher chance of mortality by 22% (HR=1.22; 95% CI:1.15-1.30), odds of unplanned hospitalizations by 33% (OR 1.33; 95% CI 1.16-1.51), and ED visits by 34% (OR 1.34; 95% CI 1.17-1.53). Overall, approximately 20% had unplanned hospitalizations unrelated to elective or scheduled treatments and 16.8% visited the ED. This association was strongest in patients with non-Hodgkin lymphoma, according to the study.
 
Additionally, grip strength appeared to strongly predict survival but did not predict hospitalization or ED use as well as gait, the researchers noted. 
 
Current standard of care stratifies treatment based on patients’ performance status, but this may not be enough in older, more frail patients, according to the study. The findings support gait speed as an independent predictor of death, even after accounting for standard physician-reported performance status.
 
“There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes,” senior author Jane A Driver, MD, MPH, associate director of the Geriatric Research Education and Clinical Center at VA Boston Healthcare System and co-director of the Dana Farber Older Adult Hematologic Malignancy Program, said in a statement. “This test can be done in less than a minute and takes no longer than measuring blood pressure or other vital signs.”
 
Integrating use of gait speed tests can allow clinicians to routinely assess older patients and better individualize care.
 
References
 
Liu MA, DuMontier C, Murillo A, et al. Gait speed, grip strength and clinical outcomes in older patients with hematologic malignancies. Blood. 2019. Doi: https://doi.org/10.1182/blood.2019000758
 
Walking Speed Predicts Clinical Outcomes in Older Adults with Blood Cancers [news release]. American Society of Hematology. https://www.hematology.org/Newsroom/Press-Releases/2019/9660.aspx. Accessed June 5, 2019.



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