Impact of a Brief Touchscreen Based Modified Geriatric Assessment on the Care of Older Adults with Multiple Myeloma

Background: Most adults (60%) diagnosed with Multiple Myeloma (MM) are > 65 years old (YO) and thus are at higher risk for toxicities of cancer treatment. Geriatric assessment (GA) can identify patients at risk for toxicity and morbidity more effectively than age or performance status, but is not easily integrated into a busy clinical setting. A technology assisted, modified GA (mGA) that includes the Palumbo frailty score can be used to summarize and report relevant clinical and self-reported symptom data to inform treatment decision making.

Methods: A prospective, single arm multisite study is underway with MM patients >65 YO to test feasibility, usability, and acceptability of a technology based mGA in a busy clinic. Patients needing a new treatment complete a tablet based survey that includes 28 items comprising the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score and Lawton Instrumental ADL (IADL) Score prior to meeting with the provider. Additional clinical information such as Creatinine Clearance (CrCl) is added by staff. The composite frailty index (FI) and items influencing the score are provided on a physician facing dashboard at the patient/provider visit. The provider reviews the mGA results with the patient and treatment is selected.

Results: To date, 118 of 210 patients have enrolled. Most participants are white (72%, n=86); mean age is 72 (range 65-85). Patients are satisfied with the computer program overall (84% indicated they are satisfied or very satisfied with the overall program), satisfied with the ease of use (91% were satisfied or very satisfied), and feel others can use the program easily (90% agreed or strongly agree others would learn to use the program quickly). Patients complete the survey in an average of 7.71 minutes (range 2-17) and providers report an average of 3.2 minutes (range 1-10) to review the mGA results. Patients were fit (38%, n=45), intermediate fit (31%, n=37) or frail (31%, n=36), and the fit/frailty status informed treatment decisions. Providers selected treatments that were more aggressive (increased dose or dose intensity) for the fit patients while frail patients received milder treatments evidenced by a reduced number of agents, regimens with less toxicity, or a different route of administration (χ² =20.02, p<.0001). There was also a significant correlation of patients considered to be transplant eligible with fit status and patients considered not transplant eligible with frail status (p=.004). There is a trend toward frail patients having more dose modifications during the 3 months follow up period (p=.09). The mGA information with greatest impact on provider treatment decisions was: fit/frailty status or the rationale for the summary score (67%, n=100), creatinine clearance (17%, n=25), peripheral neuropathy (6%, n=9) and falls (3%, n=4). Outcomes on the first 18 patients at three months post treatment decision visit show 33% had grade 3 or higher hematologic toxicities, 66% had dose modifications over the three-month study period, and 33% had therapy discontinued earlier than planned.

Conclusion: The limited additional time required by patients to complete the survey and-the provider to review the mGA results together with the high rate of patient satisfaction shows a mGA can be easily incorporated into clinical workflow. Real time scoring of assessment items into a composite score indicating fit/frailty status influenced treatment decisions at the point of care to allow aggressive treatment of fit patients and modifications to decrease toxicity in frail patients. Final study results will report patient outcomes at three months post intervention visit correlated with fit/frailty status.