TY - JOUR
T1 - Development of a medicare health outcomes survey deficit-accumulation frailty index and its application to older patients with newly diagnosed multiple myeloma
AU - Mian, Hira S.
AU - Wildes, Tanya M.
AU - Fiala, Mark A.
N1 - Publisher Copyright:
© 2018 American Society of Clinical Oncology.
PY - 2018
Y1 - 2018
N2 - Purpose To develop a frailty index using the Rockwood Accumulation of Deficits approach for the Medicare Health Outcomes Survey (MHOS) and apply it in a subset of older patients with newly diagnosed multiple myeloma. MethodsData from 2,692,361 patients without cancer, > 66 years of age, in SEER-MHOS linked databases between 1998 and 2009 were analyzed. A frailty index was constructed, resulting in a 25-item scale; cutoff values were created for individuals classified as frail. This frailty index was then applied to 305 patients with newly diagnosed myeloma in the database to predict overall survival. ResultsIn the derivation cohort of patients without cancer, the median age was 74 years and the mean frailty index was 0.23 (standard deviation, 0.17). Among patients without cancer, each 10% increase in frailty index (approximately three to four more deficits) was associated with a 40% increased risk for death (adjusted hazard ratio, 1.397; 95% CI, 1.396 to 1.399; P < .001). In the cohort of patients with newly diagnosed myeloma, the median age was 76 years and the mean frailty index was 0.28 (standard deviation, 0.17). Each 10% increase in frailty index was associated with a 16% increased risk for death (adjusted hazard ratio, 1.159; 95% CI, 1.080 to 1.244; P < .001). Fifty-three percent of patients with multiple myeloma were considered frail. The estimated median overall survival of patients considered frail was 26.8 months, compared with 43.7 months (P= .015) for those who were not. ConclusionThe MHOS-based frailty index was prognostic for patients with multiple myeloma in predicting overall survival.
AB - Purpose To develop a frailty index using the Rockwood Accumulation of Deficits approach for the Medicare Health Outcomes Survey (MHOS) and apply it in a subset of older patients with newly diagnosed multiple myeloma. MethodsData from 2,692,361 patients without cancer, > 66 years of age, in SEER-MHOS linked databases between 1998 and 2009 were analyzed. A frailty index was constructed, resulting in a 25-item scale; cutoff values were created for individuals classified as frail. This frailty index was then applied to 305 patients with newly diagnosed myeloma in the database to predict overall survival. ResultsIn the derivation cohort of patients without cancer, the median age was 74 years and the mean frailty index was 0.23 (standard deviation, 0.17). Among patients without cancer, each 10% increase in frailty index (approximately three to four more deficits) was associated with a 40% increased risk for death (adjusted hazard ratio, 1.397; 95% CI, 1.396 to 1.399; P < .001). In the cohort of patients with newly diagnosed myeloma, the median age was 76 years and the mean frailty index was 0.28 (standard deviation, 0.17). Each 10% increase in frailty index was associated with a 16% increased risk for death (adjusted hazard ratio, 1.159; 95% CI, 1.080 to 1.244; P < .001). Fifty-three percent of patients with multiple myeloma were considered frail. The estimated median overall survival of patients considered frail was 26.8 months, compared with 43.7 months (P= .015) for those who were not. ConclusionThe MHOS-based frailty index was prognostic for patients with multiple myeloma in predicting overall survival.
UR - http://www.scopus.com/inward/record.url?scp=85059989040&partnerID=8YFLogxK
U2 - 10.1200/CCI.18.00043
DO - 10.1200/CCI.18.00043
M3 - Article
C2 - 30547157
AN - SCOPUS:85059989040
VL - 2018
SP - 1
EP - 13
JO - JCO clinical cancer informatics
JF - JCO clinical cancer informatics
SN - 2473-4276
IS - 2
ER -