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Gait speed, survival, and recommended treatment intensity in older adults with blood cancer requiring treatment
Author(s) -
Hantel Andrew,
DuMontier Clark,
Odejide Oreofe O.,
Luskin Marlise R.,
Sperling Adam S.,
Hshieh Tammy,
Chen Richard,
Soiffer Robert,
Driver Jane A.,
Abel Gregory A.
Publication year - 2021
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33344
Subject(s) - medicine , proportional hazards model , logistic regression , hazard ratio , gait , intensity (physics) , cancer , preferred walking speed , physical therapy , confidence interval , physics , quantum mechanics
Background Brief measures of physical function such as gait speed may be useful to optimize treatment intensity for older adults who have blood cancer; however, little is known about whether such assessments are already captured within oncologists' “gestalt” assessments. Methods Gait speed was assessed in 782 patients ≥75 years of age who had blood cancer, with results reported to providers after treatment decisions were made; 408 patients required treatment when different intensities were available per National Comprehensive Cancer Network (NCCN) guidelines. We performed structured abstractions of treatment intensity recommendations into standard intensity, reduced intensity, or supportive care, based on NCCN guidelines. We modeled gait speed and survival using Cox regression and performed ordinal logistic regression to assess predictors of NCCN‐based categorizations of oncologists' treatment intensity recommendations, including gait speed. Results The median survival by gait speed category was 10.8 months (<0.4 m/s), 18.6 months (0.4‐0.6 m/s), 34.0 months (0.6‐0.8 m/s), and unreached (>0.8 m/s). Univariable hazard ratios (HRs) for death increased for each lower category compared with ≥0.8 m/s (0.6‐0.8 m/s: HR, 1.76; 0.4‐0.6 m/s: HR, 2.30; <0.4 m/s: HR, 3.31). Gait speed predicted survival in multivariable Cox regression (all P < .05). In multivariable models including age, sex, and Eastern Cooperative Oncology Group performance status, gait speed did not predict oncologists' recommended treatment intensity (all P > .05) and did not add to a base model predicting recommended treatment intensity. Conclusion In older adults with blood cancer who presented for treatment, gait speed predicted survival but not treatment intensity recommendation. Incorporating gait speed into decision making may improve optimal treatment selection.