Quiz: Understand How to Assess Frailty in Multiple Myeloma Patients

Question 1

Answer

D.All of the above

The IMWG frailty scoring system includes age, deficits and impairments in activities of daily living, and the Charlson Comorbidity Index. Frailty is a state of diminished neurocognitive and physical reserve that reduces the patient’s ability to withstand some intensive cancer treatment regimens and is associated with an increased risk of treatment-related toxicities. Frailty scoring therefore commonly informs treatment decision making for elderly patients.

Question 2

Answer

C.57%

A recent cohort analysis published in the Journal of Geriatric Oncology compared IMWG and Fried frailty scores for 98 patients who were at least 75 years at the time of diagnosis with multiple myeloma. The authors found a 57% discordance among frailty classifications between the two scores, with IMWG scoring identifying 62% of patients as “frail” and Fried identifying only 19% as frail. The IMWG frailty score includes age, but the Fried scoring system does not; including patient age causes an over-classification of patients to the “frail” category, the study author's suspect.

Question 3

Answer

C.Overall survival

Fried system scores categorizing patients as “frail” were significantly predictive of overall survival (P = .04), whereas IMWG-assessed frailty was not. The authors concluded that among older patients with myeloma, the Fried frailty score is more informative and that including patient age in frailty scoring might unnecessarily limit treatment options for older patients who are misclassified as frail because of their chronological age.

Question 4

Answer

D.All of the above

The Fried model defines frailty as the presence of any three of five factors: unintended weight loss, self-reported exhaustion, low energy expenditure, slow gait speed, and/or weak grip strength. Patients with none of these are categorized as “robust” (fit).

Question 5

Answer

D.All of the above

A recent retrospective analysis of data for 3,800 patients with active multiple myeloma in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER)-Medicare database showed that older age, poor performance status, comorbidities, African American race, lower socioeconomic status, and Medicaid enrollment are all significantly associated with the risk of receiving no systemic antimyeloma therapies. This is based on insurance claims for such treatments.