Geriatric assessment in older patients with a haematological malignancy.

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The aim of this systematic review is to give an update of all currently available evidence of the relevance of a geriatric assessment in treatment of older patients with haematological malignancies.A systematic search in MEDLINE and EMBASE was performed to find studies in which a geriatric assessment was used to detect impaired geriatric domains or to address the association between geriatric assessment and survival or clinical outcome measures.The literature search included 4629 reports, of which 54 publications from 44 studies were included. 73% of the studies were published in the last five years. Median age of patients was 73 (range 58-86) and 71% had a good WHO performance status. The median prevalence of geriatric impairments varies between 17% to 68%, even in patients with a good WHO performance status. Polypharmacy, nutritional status and instrumental activities of daily living were most frequently impaired. Whereas several geriatric impairments and frailty (based on a frailty screening tool or summarised geriatric assessment score) were predictive for a shorter overall survival, WHO performance status lost its predictive value in most studies. The association between geriatric impairments with treatment-related toxicity varies, with a trend towards a higher risk for (non-)haematological toxicity in frail patients. During follow up, frailty seems to be associated with treatment non-completion, especially when patients are malnourished. Patients with a good physical capacity had a shorter hospital stay and reduced hospitalization rate.Geriatric assessment, even in patients with a good performance status, can detect impaired geriatric domains and these impairments may be predictive for mortality. Moreover, geriatric impairments suggests a higher risk of treatment-related toxicity, treatment non-completion and using health care services. Before starting treatment in older patients with haematological malignancies a geriatric assessment should be considered.


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