Study Highlights Importance of Assessing Frailty and QOL in Patients with Myelodysplastic Syndromes

A study presented at the 62nd ASH Annual Meeting & Exposition found that patients with myelodysplastic syndromes (MDS), even low-grade disease, have similar problems with patient-reported outcomes (PROs) as patients with other cancers and that frailty is highly associated with less favorable PROs.

Patients categorized as frail had significantly worse quality of life (QOL), highlighting the importance of assessing frailty and QOL in patients with MDS to ensure that outcomes are satisfactory.

“The heterogeneous composition of disease states grouped together as ‘MDS’ increases the difficulty of assessing and understanding these outcomes. Moreover, little is known about the potential relationship between QOL and frailty in this population,” explained the presenters, led by Gregory A. Abel, MD, MPH, of Dana-Farber Cancer Institute, Boston, Mass.

The researchers used the National Heart, Lung, and Blood Institute’s MDS Natural History Study, a prospective cohort of 2,000 adults recently diagnosed with MDS and 500 adults with idiopathic cytopenia of undetermined significance. The MDS Natural History Study collects:

  • Biological specimens (e.g., bone marrow, blood)
  • Medical information, including information about treatments received
  • Details about symptoms
  • Assessments of frailty (using the Vulnerable Elders Survey [VES-13])
  • Data on PROs as assessed with validated instruments, including the Quality of Life in Myelodysplasia Scale, the Functional Assessment of Cancer Therapy–General, the Patient-Reported Outcome Measurement Information System FatigueShort Form, and the EQ-5D-5L

The researchers found that the 216 patients with confirmed MDS experienced similar problems with QOL as patients with other cancers. The most common problems associated with frailty on the VES-13 were:

  • Age 75 years or older
  • Overall rating of health as poor or fair
  • Difficulty with extended physical activity, such as walking a quarter-mile
  • Heavy housework
  • Needing help with activities of daily living, such as shopping or managing money

Frail patients had significantly worse PROs than non-frail participants for all measures.

The researchers stressed that clinicians should not only observe how patients appear and move during clinic visits but also specifically evaluate how these patients may be handling prolonged physical activity and activities of daily living.