New research indicates lower survival in patients with slower gait speed.
Gait speed may matter much more than previously recognized when it comes to patients over age 75 with non-Hodgkin’s lymphoma. Researchers at Dana-Farber Cancer Institute and the VA Boston Healthcare System are now reporting that a slower walking pace appears to be associated with a lower survival and an increased likelihood of hospitalization in patients with hematologic malignancies. The research team just published a study demonstrating that gait speed may be a useful tool to better tailor care because it may more accurately identify frailty and better predict outcomes independent of performance status (PS).
In the journal Blood, the researchers report that for every 0.1 meter per second decrease in how fast a patient walks four meters increases their risk of dying by 22%. This same decrease in gait speed also was associated with a 33% increased risk for unexpectedly going to the hospital and a 34% increased risk for requiring an emergency room visit.
The association between slower walking speed and poorer outcomes persisted even after the researchers adjusted for cancer type, disease aggressiveness, patient age, other demographic factors, as well as traditional measures of frailty and functional status. When the team looked at ECOG performance status (0 or 1), the associations remained strong and every 5 kg decrease in grip strength was found to be associated with worse survival (adjusted HR =1.24), but not with unexpected hospitalization or emergency room use.
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The researchers looked at 448 patients who had hematologic cancers and were age 75 or older (mean age: 79.7 years). All the patients completed several screenings for cognition, frailty, gait, and grip strength. The team used the National Institutes of Health 4-meter gait speed test. In this current study, the association between slower walking speed and a higher risk of complications was strongest in the patients with non-Hodgkin’s lymphoma.
Patients received a PS rating as part of this investigation and they were stratified into three groups by gait speed (at risk or frail, pre-frail, or robust). Among the 314 patients, nearly 20% experienced an unplanned hospital stay and 16.8% required emergency room care. The findings suggests that the current functional assessment in oncology with PS may not be sufficient for older patients with hematologic malignancies. The authors note this is a critical issue because frailty can be particularly prevalent among older patients with hematologic malignancies. Studies suggest that more than 50% of these patients have evidence of malnutrition, and up to one-third may have impaired physical function.
The gait assessment test used in this study takes only a few minutes to conduct and basically requires no more time than it does to measure blood pressure or other vital signs. Oncologist Adil Akhtar MD, associate professor in the Department of Medical Oncology & Hematology at Oakland University-William Beaumont School of Medicine, Detroit, says the findings from this study are highly relevant. He says in older patients with hematological malignancies function status and frailty can predict how a patient may tolerate an aggressive chemotherapy regimen.
PS is the most commonly use tool to measure functional status in oncology patients. However, Dr. Akhtar says clinicians are aware it has limitations when applying it to older and/or frail patients. “This study provides strong data to support a role for gait speed in the decision-making process for the elderly patients with hematological malignancies. In my opinion, more studies are required to validate these results before a widespread adoption of this tool in clinical practice,” Dr. Akhtar tells Drug Topics. “In addition to the predictive value, more research is needed to see if gait speed can be utilized in making important decisions about treatment regimens, intensity of regimens, or changing treatments.”