Integrating Touchscreen-based Geriatric Assessment and Frailty Screening for Adults with AML to Drive Personalized Treatment Decisions

Authors: Omer Jamy, MD¹, Stacey Ingram, MEd², D’Ambra Dent², William Dudley, PhD³, Matthew Dudley³, Julie Scott MSN⁴, Debra Wujcik, PhD⁴

1. Division of Hematology and Oncology, UAB, Birmingham, AL;
2. University of Alabama at Birmingham;
3. Piedmont Research Strategies, Greensboro, NC;
4. Carevive Systems Inc. 

Background

• Acute Myeloid Leukemia (AML) is a disease of older patients
• NCCN guidelines recommend geriatric assessments as complementary for toxicity risk assessment in patients 60 years and older
• Utility of geriatric assessment (GA) in older AML patients in a real-world environment is not yet established

Objective

The primary objectives of this study were:

• to test the feasibility of using a modified GA (mGA), administered by patient self-report on a touchscreen computer, real-time use and utility by clinicians
• to determine the correlation of mGA results on treatment decision-making

Methods

 Study Design

• This was a prospective single-arm study evaluating feasibility of completion of a modified Geriatric Assessment (mGA) at a treatment decision visit

Participants

• Patients aged 60 and older with AML were enrolled from three sites
• Newly diagnosed or starting a new line of therapy and have not yet made a treatment decision

Instrument

• The mGA includes four domains: age, activities of daily living (ADLs), instrumental ADLs, and comorbidities. Results were reported as a) fit, b) intermediate fit, and c) frail
• Survey results along with history of falls was used to create the Frailty Index (Fl)

Data Collection

• Patients completed the mGA prior to the treatment decision visit with the clinician
• Providers were asked what they thought the fit/frailty status of the patient was before viewing the Fl results on a dashboard. After viewing the survey results, the clinician discussed the treatment plan with the patient
• Treatment was recorded as intensive or non-intensive therapy
• Baseline and 3-month surveys recorded presence and severity of 8 symptoms using the Edmonton Symptom Assessment Scale (ESAS) with O=no symptom and 1 O=worst possible symptom

Analysis

• Feasibility was measured as completion of surveys, provider review of results before seeing the patient, and time required for review of results
• Correlation of results or treatment decision making was calculated by
  • concordance of physician predicted and mGA Fl
  • correlation of Fl with treatment intensity

Results

Significant symptom improvement at 3 months was seen for drowsiness, lack of appetite, shortness of breath, and anxiety.

Patients received intensive therapy, non intensive therapy or were enrolled in a clinical trial.

• Of the 25 patients whose treatment decision was influenced by the mGA results, more fit patients received intensive therapy and most intermediate and frail patients received non intensive therapy

Discussion

• There was nearly 40% discordance between the provider and mGA results, with the most discordance on the intermediate fit status.
• Results of the mGA influenced treatment decision making in one third of provider/patient interactions.
• Further analysis of the mGA domains is warranted to see if additional insights can be gained.
• With time, some symptoms improve, and others don’t. This points to the opportunity to direct resources towards symptom assessment during treatment.
• Feasibility was demonstrated in this study as providers received the aggregated results in real time and reviewed them in less than 5 minutes. In addition, patients were able to complete the survey unassisted without disturbing clinic operations.

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