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Validation of the G8 in older patients with a haematological malignancy
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
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Physical performance and inflammatory markers in relation to nutritional status in older subjects A. Skalska , M. Fedyk-Łukasik , B. Gryglewska , T. Grodzicki Department of Internal Medicine and Gerontology Jagiellonian University Medical College, Poland Introduction.– The aim of the study was to assess the correlates of poor nutritional status of elderly subjects. Methods.– Comprehensive geriatric assessment (Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Katz’s Index, Lawton scale) was performed in 89 subjects aged 60 years and older. Physical performance was assessed using 6-Minute Walk Test (6MWT), walking speed (V) and handgrip strength. Markers of inflammation: hsCRP, TNFalfa-soluble receptor2 (STNFR2), IL-6, IL-8, IL-18, pentraxin (PTX) and osteoprotegerin (OPG) were measured. Using dual energy Xray absorptiometry (DXA) lean body mass total (LBM) and appendicular (aLM) were measured, aLM index was calculated: aLMIx = aLM(kg)/height(m2 ). Results.– Out of 89 patients (mean age 72.8 ± 7,6) MNA < 24 had 30.3%. Subjects in good nutritional status and at risk of malnutrition did not differ in age, but had lower MMSE (P = 0.025), handgrip strength (14.0 ± 7.9 vs 22.79 ± 10.97 kg, P = 0.0019), lower hemoglobin (12.82 ± 1.5 vs 14.07 ± 1.5 g/dl, P = 0.0006), and albumin level (41.82 ± 3.6 vs 43.48 ± 2.7, P = 0.026). Patients with lower MNA had lower LBM (41.51 ± 7.71 vs 48.67 ± 7.24 kg, P = 0.001), aLM (16.85 ± 3.5 vs 20.68 ± 3.4 kg; P = 0.0003) and aLMIx (6.64 ± 0.99vs7.52 ± 0.86 kg/m2, P = 0.001), and performed worse physical tests: had shorter 6-MWT distance (308.89 ± 7682 vs 362.55 ± 107.5 m; P = 0.03), lower V (0.761 ± 0.23 vs 0.935 ± 0.3 m/s; P = 0.03). MNA < 24 was associated with higher OPG (9.851 ± 3.45 vs 8.094 ± 2.5, P = 0.013), and STNFR2 (P = 0.039). MNA correlated positively with 6MWT (r = 0.3, P = 0.04), V (r = 0.44, P = 0.002), handgrip strength (r = 0.42, P = 0.003), LBM (r = 0.29, P = 0.04), aLM (r = 0.32,P = 0.03), aLMIx (r = 0.20, P = 0.047) and negatively with age (r = –0.33,P = 0.02). In multiple regression analysis MNA was influenced by MMSE positively and negatively by hsCRP, IL-8 and number of diseases. Conclusions.– Risk of malnutrition in elderly was associated with worse physical performance, cognitive impairment, comorbidity, higher osteoprotegerin and inflammatory markers. http://dx.doi.org/10.1016/j.eurger.2013.07.226 P165
Is screening for malnutrition useful in older patients with aggressive haematological malignancies? A. Velghe , L. Noens , R. Demuynck , M. Petrovic Department of Geriatrics, Department of Haematology, Ghent University Hospital, Ghent, Belgium Introduction.– Malnutrition is frequent after the age of 70. It is a common feature in many types of cancer and responsible not only for a poor quality of life and poor treatment response but also for a shorter survival time. Early detection is important to allow targeted interventions. Patients with haematological malignancies have specific challenges associated with eating and nutrition because of the intensive treatments they endure. However, studies focusing on this aspect are scarce. We aimed to establish the usefulness of malnutrition screening in older patients considered for intensive chemotherapy. Methods.– Patients ≥ 70 years, with an aggressive haematological malignancy were enrolled. Before the start of therapy a geriatric assessment was completed for each patient. To screen for malnu-
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trition, we used the Mini Nutritional Assessment Short Form (MNA SF). Results.– Fifty patients were included, median age 76 years (range 70–87). Sixteen percent of the patients (n = 8) were malnourished and 66% (n = 33) were at risk. Of the malnourished patients, 50% (n = 4) had a BMI > 23. Apart from their haematological diagnosis, recent weight loss and declined food intake were the main MNA SF parameters predicting (risk of) malnutrition. For 12 patients (29%), (risk of) malnutrition was the only impairment detected by CGA. Conclusion.– Prevalence of (risk for) malnutrition in older patients with aggressive haematological malignancies is high and will further increase once chemotherapy has started. Instead of screening for malnutrition, nutritional assessment by a dietician, individualized dietary advice and follow up during treatment, should become a fundamental item in the treatment plan. http://dx.doi.org/10.1016/j.eurger.2013.07.227 P166
Validation of the G8 in older patients with a haematological malignancy A. Velghe , M. Petrovic , S. Debuyser , R. Demuynck , L. Noens Department of Geriatrics, Department of Haematology, Ghent University Hospital, Ghent, Belgium Introduction.– Haematologists are more and more confronted with treatment decision making in older patients. However, the group of older patients is very heterogeneous with more comorbidities, more often a poor performance status and less tolerance to intensive therapy. The International Society of Geriatric Oncology recommends the use of comprehensive geriatric assessment (CGA) in older cancer patients to identify frail patients in need of a tailored treatment. The G8 has been validated as a screening tool to select those patients for whom CGA might be most beneficial. We tested the performance of the G8 in older patients with an aggressive haematological malignancy. Methods.– Patients, 70 years or older, with a new diagnosis of Acute Myeloid Leukemia, Myelodysplastic Syndrome, Multiple Myeloma or Non Hodgkin Lymphoma were enrolled. G8 and CGA were completed before start of therapy. Patients were considered frail when scoring abnormal for at least one CGA domain. Results.– Fifty patients were included, median age 76 years (range 70–87). The AUC-value of 0.949 (95% CI 0.889–1.00) indicates that the G8 has a high diagnostic accuracy to identify disabilities. At the cut-off score proposed in the literature (G8 ≤ 14), a sensitivity of 88.6% and a specificity of 100% was obtained. In 88% of patients at least one impairment was detected with a majority scoring positive on (risk for) malnutrition. Conclusion.– Our results show that the G8 can be used as a valid screening tool for older patients with aggressive haematological malignancies to identify frail patients who would benefit from CGA. http://dx.doi.org/10.1016/j.eurger.2013.07.228 P167
Muscle mass associates to the cadans-velocity connection in older women A.M. De Cock AZ St Maarten-Emmaus„ Mechelen, Belgium Introduction.– Bio-impedance analysis (BIA) and gait speed registration can be used in sarcopenia research according to the European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. We questioned the relationship of muscle mass parameters to different gait speeds and other gait characteristics. Method.– Elderly women consecutively entering the geriatric daysclinic and the geriatric ward were selected. They all performed
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Physical performance and inflammatory markers in relation to nutritional status in older subjects A. Skalska , M. Fedyk-Łukasik , B. Gryglewska , T. Grodzicki Department of Internal Medicine and Gerontology Jagiellonian University Medical College, Poland Introduction.– The aim of the study was to assess the correlates of poor nutritional status of elderly subjects. Methods.– Comprehensive geriatric assessment (Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Katz’s Index, Lawton scale) was performed in 89 subjects aged 60 years and older. Physical performance was assessed using 6-Minute Walk Test (6MWT), walking speed (V) and handgrip strength. Markers of inflammation: hsCRP, TNFalfa-soluble receptor2 (STNFR2), IL-6, IL-8, IL-18, pentraxin (PTX) and osteoprotegerin (OPG) were measured. Using dual energy Xray absorptiometry (DXA) lean body mass total (LBM) and appendicular (aLM) were measured, aLM index was calculated: aLMIx = aLM(kg)/height(m2 ). Results.– Out of 89 patients (mean age 72.8 ± 7,6) MNA < 24 had 30.3%. Subjects in good nutritional status and at risk of malnutrition did not differ in age, but had lower MMSE (P = 0.025), handgrip strength (14.0 ± 7.9 vs 22.79 ± 10.97 kg, P = 0.0019), lower hemoglobin (12.82 ± 1.5 vs 14.07 ± 1.5 g/dl, P = 0.0006), and albumin level (41.82 ± 3.6 vs 43.48 ± 2.7, P = 0.026). Patients with lower MNA had lower LBM (41.51 ± 7.71 vs 48.67 ± 7.24 kg, P = 0.001), aLM (16.85 ± 3.5 vs 20.68 ± 3.4 kg; P = 0.0003) and aLMIx (6.64 ± 0.99vs7.52 ± 0.86 kg/m2, P = 0.001), and performed worse physical tests: had shorter 6-MWT distance (308.89 ± 7682 vs 362.55 ± 107.5 m; P = 0.03), lower V (0.761 ± 0.23 vs 0.935 ± 0.3 m/s; P = 0.03). MNA < 24 was associated with higher OPG (9.851 ± 3.45 vs 8.094 ± 2.5, P = 0.013), and STNFR2 (P = 0.039). MNA correlated positively with 6MWT (r = 0.3, P = 0.04), V (r = 0.44, P = 0.002), handgrip strength (r = 0.42, P = 0.003), LBM (r = 0.29, P = 0.04), aLM (r = 0.32,P = 0.03), aLMIx (r = 0.20, P = 0.047) and negatively with age (r = –0.33,P = 0.02). In multiple regression analysis MNA was influenced by MMSE positively and negatively by hsCRP, IL-8 and number of diseases. Conclusions.– Risk of malnutrition in elderly was associated with worse physical performance, cognitive impairment, comorbidity, higher osteoprotegerin and inflammatory markers. http://dx.doi.org/10.1016/j.eurger.2013.07.226 P165
Is screening for malnutrition useful in older patients with aggressive haematological malignancies? A. Velghe , L. Noens , R. Demuynck , M. Petrovic Department of Geriatrics, Department of Haematology, Ghent University Hospital, Ghent, Belgium Introduction.– Malnutrition is frequent after the age of 70. It is a common feature in many types of cancer and responsible not only for a poor quality of life and poor treatment response but also for a shorter survival time. Early detection is important to allow targeted interventions. Patients with haematological malignancies have specific challenges associated with eating and nutrition because of the intensive treatments they endure. However, studies focusing on this aspect are scarce. We aimed to establish the usefulness of malnutrition screening in older patients considered for intensive chemotherapy. Methods.– Patients ≥ 70 years, with an aggressive haematological malignancy were enrolled. Before the start of therapy a geriatric assessment was completed for each patient. To screen for malnu-
S69
trition, we used the Mini Nutritional Assessment Short Form (MNA SF). Results.– Fifty patients were included, median age 76 years (range 70–87). Sixteen percent of the patients (n = 8) were malnourished and 66% (n = 33) were at risk. Of the malnourished patients, 50% (n = 4) had a BMI > 23. Apart from their haematological diagnosis, recent weight loss and declined food intake were the main MNA SF parameters predicting (risk of) malnutrition. For 12 patients (29%), (risk of) malnutrition was the only impairment detected by CGA. Conclusion.– Prevalence of (risk for) malnutrition in older patients with aggressive haematological malignancies is high and will further increase once chemotherapy has started. Instead of screening for malnutrition, nutritional assessment by a dietician, individualized dietary advice and follow up during treatment, should become a fundamental item in the treatment plan. http://dx.doi.org/10.1016/j.eurger.2013.07.227 P166
Validation of the G8 in older patients with a haematological malignancy A. Velghe , M. Petrovic , S. Debuyser , R. Demuynck , L. Noens Department of Geriatrics, Department of Haematology, Ghent University Hospital, Ghent, Belgium Introduction.– Haematologists are more and more confronted with treatment decision making in older patients. However, the group of older patients is very heterogeneous with more comorbidities, more often a poor performance status and less tolerance to intensive therapy. The International Society of Geriatric Oncology recommends the use of comprehensive geriatric assessment (CGA) in older cancer patients to identify frail patients in need of a tailored treatment. The G8 has been validated as a screening tool to select those patients for whom CGA might be most beneficial. We tested the performance of the G8 in older patients with an aggressive haematological malignancy. Methods.– Patients, 70 years or older, with a new diagnosis of Acute Myeloid Leukemia, Myelodysplastic Syndrome, Multiple Myeloma or Non Hodgkin Lymphoma were enrolled. G8 and CGA were completed before start of therapy. Patients were considered frail when scoring abnormal for at least one CGA domain. Results.– Fifty patients were included, median age 76 years (range 70–87). The AUC-value of 0.949 (95% CI 0.889–1.00) indicates that the G8 has a high diagnostic accuracy to identify disabilities. At the cut-off score proposed in the literature (G8 ≤ 14), a sensitivity of 88.6% and a specificity of 100% was obtained. In 88% of patients at least one impairment was detected with a majority scoring positive on (risk for) malnutrition. Conclusion.– Our results show that the G8 can be used as a valid screening tool for older patients with aggressive haematological malignancies to identify frail patients who would benefit from CGA. http://dx.doi.org/10.1016/j.eurger.2013.07.228 P167
Muscle mass associates to the cadans-velocity connection in older women A.M. De Cock AZ St Maarten-Emmaus„ Mechelen, Belgium Introduction.– Bio-impedance analysis (BIA) and gait speed registration can be used in sarcopenia research according to the European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. We questioned the relationship of muscle mass parameters to different gait speeds and other gait characteristics. Method.– Elderly women consecutively entering the geriatric daysclinic and the geriatric ward were selected. They all performed