PS1502 VALIDATION OF HAND GRIP STRENGTH AS A SCREENING TOOL FOR FRAILTY IN OLDER PATIENTS ON TREATMENT FOR HEMATOLOGIC MALIGNANCIES: THE FRAILTY TASK FORCE STUDY
Authors: Guglielmelli T. , Rrodhe S. , Baroso A. , Berchialla P. , Parvis G. , Cilloni D. , Saglio G. , Guerrasio A. 
Published: June 2019

Background:

Frailty is a common and important geriatric syndrome characterized by age‐associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major definitions of frailty have emerged over the past years: 1) the frailty phenotype (FP) defined by at least three or five items between weakness, slowness, low physical activity, low energy and weight loss 2) frailty index (FI) based on a comprehensive geriatric assessment (CGA) that evaluates functional status, polypharmacy, comorbidity, emotional and cognitive mental health status, fatigue, socio‐economic condition, nutrition and quality of life. In patients with cancer, the identification of frailty might be relevant to choose the most appropriate therapy for each patient. In hematology the CGA is not routinely performed because it is complex and time‐consuming. Hand Grip strength (HGS) is a general indicator of muscle strength and low HGS has been linked with premature mortality.

Aims:

The aim of this study was to test HGS as screening tool for frailty in older patients with hematologic malignancies.

Methods:

Patients ≥ 70 years on treatment for Acute Myeloid Leukemia (AML), Myelodysplastic Syndrome (MDS), Multiple Myeloma (MM), Chronic Linfocytic Leukemia (CLL) and Non Hodgkin Lymphoma (NHL) who were referred to the hematology department of two centers were included in the study. HGS was evaluated with a Jamar dynamometer and CGA was performed with a set of four questionnaires: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), G8 screening questionnaire, Cumulative Illness Rating Scale (CIRS). Frailty was defined according to the following cut‐off: ADL (>4 ≤4), IADL (>5 ≤5),G8 (>14 ≤14), CIRS ≥1 score 3–4 or > 8 score 2. Spearman's Rank coefficient was used to evaluate the correlation between HGS and questionnaires score. Age and sex‐adjusted logistic regression model was used to evaluate the association between HGS and frailty. The performance of the HGS screening tool was evaluated using Receiver Operating Curve (ROC) analysis and the area under the ROC curve (AUC). Sensitivity and specificity with 95% confidence interval were calculated. Analysis were performed using the software R version 3.5.0.

Results:

One hundred and eleven patients were included in the study (12 AML 10.8%, 6 MDS 5,4%, 39 MM 35.1%, 11 CLL 9.9% and 43 NHL 38.7%). Median age was 78 ± 4.7 with 42 patients ≥ 80 years (37.8%). The male/female ratio was 66 (59.5%)/45 (40.5%).

Overall, HGS significantly correlated with ADL score (r = 0.45 p < 0.001 for men and r = 0.49 p < 0.001 for women), IADL score (r = 0.5 p < 0.001 for men and r = 0.4 p < 0.001 for women), G8 score (r = 0.57 p < 0.05 for men and r = 0.051 p < 0.001 for women) but not with CIRS score.

Age and sex‐adjusted logistic regression analysis demonstrated an association between low HGS and frailty in patients with 2 additive scores in ADL, IADL or G8 but not CIRS (OR = 0.021, p = 0.003). In these patients ROC curves of HGS as screening tool for frailty evidenced AUC 87.4% (95%CI: 77.4%>97.4%) in women and 84% (95%CI 72.2%>96.1%) in men. Moreover, the ROC curves revealed an HGS score ≤14 Kg in women (82.1% sensitivity and 70.6% specificity) and ≤25 Kg in men (91.8% sensitivity and 70.6% specificity) as the optimal cut‐off point according to the best Youden index.

Summary/Conclusion:

HGS is a valid, reliable, rapid and sensible clinical measure of frailty.