A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: The International Prognostic Scoring System (IPSS) for myelodysplastic syndrome (MDS) is commonly used to predict survival and assign treatment. We explored whether markers of frailty add prognostic information to the IPSS in a cohort of older patients.
Design, Setting, Participants: Retrospective cohort study of 114 MDS patients ≥ age 65 who presented to Dana‐Farber Cancer Institute between 2006‐2011 and completed a baseline quality of life questionnaire.
Measurements: We evaluated questions corresponding to frailty and extracted clinical‐ pathologic data from medical records. We used Kaplan‐Meier and Cox proportional hazards models to estimate survival.
Results: 114 patients consented and were available for analysis. The median age was 72.5 years, and the majority of patients were white ( 94.7%), male ( 74.6%), and over half had a Charlson comorbidity score < 2. Few patients ( 23.7%) had an IPSS score consistent with low‐risk disease and the majority received chemotherapy. In addition to traditional prognostic factors (IPSS score and history of prior chemotherapy or radiation), significant univariate predictors of survival included low serum albumin, Charlson score, the ability to take a long walk, and interference of physical symptoms in family life. The multivariate model that best predicted mortality included low serum albumin (HR=2.3; 95%CI: 1.06‐5.14), previous chemotherapy or radiation (HR=2.1;
95%CI: 1.16‐4.24), IPSS score (HR=1.7; 95%CI: 1.14‐2.49), and ease taking a long walk (HR=0.44;
95%CI: 0.23‐0.90).
Conclusions: In this study of older adults with MDS, we found that markers of nutritional status and self‐reported physical function added important prognostic information to the IPSS score. More comprehensive risk assessment tools for older patients with MDS that include markers of function and frailty are needed.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/528170 |
| Date | 10 April 2015 |
| Creators | Fegas, Rebecca K. |
| Contributors | The University of Arizona College of Medicine - Phoenix, Driver, Jane MD, MPH |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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