The role of grip strength and short physical performance battery test in predicting chemotherapy-related outcomes in older adults with cancer

Analysis of Inertial Measurement Unit Data for an AI-Based Physical Function Assessment System Using In-Clinic-like Movements

Assessing objective physical function in patients with cancer is crucial for evaluating their ability to tolerate invasive treatments. Current assessment methods, such as the timed up and go (TUG) test and the short physical performance battery, tend to require additional resources and time, limiting their practicality in routine clinical practice. To address these challenges, we developed a system to assess physical function based on movements observed during clinical consultations and aimed to explore relevant features from inertial measurement unit data collected during those movements. As for the flow of the research, we first collected inertial measurement unit data from 61 patients with cancer while they replicated a series of movements in a consultation room. We then conducted correlation analyses to identify keypoints of focus and developed machine learning models to predict the TUG test outcomes using the extracted features. Regarding results, pelvic velocity variability (PVV) was identified using Lasso regression. A linear regression model using PVV as the input variable achieved a mean absolute error of 1.322 s and a correlation of 0.713 with the measured TUG results during five-fold cross-validation. Higher PVV correlated with shorter TUG test results. These findings provide a foundation for the development of an artificial intelligence-based physical function assessment system that operates without the need for additional resources.

Introduction of AI Technology for Objective Physical Function Assessment

Objective physical function assessment is crucial for determining patient eligibility for treatment and adjusting the treatment intensity. Existing assessments, such as performance status, are not well standardized, despite their frequent use in daily clinical practice. This paper explored how artificial intelligence (AI) could predict physical function scores from various patient data sources and reviewed methods to measure objective physical function using this technology. This review included relevant articles published in English that were retrieved from PubMed. These studies utilized AI technology to predict physical function indices from patient data extracted from videos, sensors, or electronic health records, thereby eliminating manual measurements. Studies that used AI technology solely to automate traditional evaluations were excluded. These technologies are recommended for future clinical systems that perform repeated objective physical function assessments in all patients without requiring extra time, personnel, or resources. This enables the detection of minimal changes in a patient's condition, enabling early intervention and enhanced outcomes.

Functional assessment in patients with castration-resistant prostate cancer treated with darolutamide: results from the DaroAcT study

BACKGROUND

Androgen receptor inhibitors (ARIs) are approved for the treatment of advanced prostate cancer; however, some patients may experience symptoms and side effects that hinder their physical functioning. The Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests are used to assess physical functioning in older adults and are recommended assessments for patients with prostate cancer, despite lacking validation in this setting.

METHODS

DaroAct (NCT04157088) was an open-label, multicenter, phase 2b study designed to evaluate the effects of the ARI darolutamide (lead-in phase) and darolutamide vs enzalutamide (randomized phase) on physical functioning in men with castration-resistant prostate cancer (CRPC). Only the lead-in phase, in which participants received darolutamide 600 mg twice daily, was completed. The TUG and SPPB tests were used to assess physical functioning.

RESULTS

The lead-in phase enrolled 30 participants. During 24 weeks of treatment, 8 (32.0%) of 25 evaluable participants exhibited clinically meaningful worsening in TUG from baseline (primary endpoint). At the week 24 visit, 5 (21.7%) of 23 participants had worsening in TUG time, and 8 (33.3%) of 24 participants had worsening in SPPB score. Because only 48% of participants had the same outcome on the TUG and SPPB tests, the study was terminated without initiating the randomized comparison.

CONCLUSION

Most participants showed no clinically meaningful worsening in physical functioning after 24 weeks of darolutamide treatment, but poor agreement between tests was observed. Tools to accurately and consistently measure the impact of ARIs on physical functioning in patients with CRPC are needed.

The FITNESS study: longitudinal geriatric assessment, treatment toxicity, and biospecimen collection to assess functional disability among older adults with lung cancer

Introduction

Older adults with chronic disease prioritize functional independence. We aimed to describe the feasibility of capturing functional disability and treatment toxicity among older adults with lung cancer using a longitudinal comprehensive geriatric assessment (CGA) and molecular biomarkers of aging.

Methods

This prospective study included adults ≥60 years with any newly diagnosed non-small-cell lung cancer. Participants were recruited from central Ohio (2018-2020). Study assessments included the Cancer and Aging Research Group CGA (CARG-CGA), short physical performance battery (SPPB), and the blessed orientation-memory concentration (BOMC) test at baseline, 3, 6, and 12 months. Activities of daily living (ADLs) and instrumental ADLs (IADLs), quality of life (QoL, PROMIS 10), and treatment toxicity were captured monthly. Stool and blood were collected to characterize the gut microbiome and age-related blood biomarkers.

Results

This study enrolled 50 participants with an average age of 71.7 years. Ninety-two percent of participants were Caucasian, 58% were male, and all were non-Hispanic. Most had advanced stage (stage III/IV: 90%; stage I/II: 10%), with adenocarcinoma the predominant histologic subtype (68% vs. 24% squamous). First-line treatments included chemotherapy (44%), immune checkpoint inhibitors (ICIs, 22%), chemotherapy and ICIs (30%), or tyrosine kinase inhibitors (4%). The median baseline CARG toxicity score was 8 (range 2-12). Among patients with treatment-related toxicity (n = 49), 39 (79.6%) cases were mild (grade 1-2), and 10 (20.4%) were moderate to severe (≥ grade 3). Treatment toxicity was greater among those with a CARG score ≥8 (28.0% vs. 13.6%). Higher IADL independence, QoL, and SPPB scores at baseline were positively associated with Candidatus Gastranaerophilales bacterium, Lactobacillus rogosae, and Enterobacteria phage P4. Romboutsia ilealis, Streptococcus, and Lachnoclostridium sp An138 and T cell lag3 and cd8a were associated with worse IADLs, QoL, and SPPB scores at baseline.

Discussion

A longitudinal CGA and biomarker collection is feasible among older adults undergoing lung cancer treatment. Gut microbe and T cell gene expression changes correlated with subjective and objective functional status assessments. Future research will test causality in these associations to improve outcomes through novel supportive care interventions to prevent functional disability.

Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative

As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.

Treatment Individualization in Diffuse Large B-Cell Lymphoma: Is Frailty Enough for Old Adults? An Original Article

INTRODUCTION

Toxicity risk evaluation based on frailty assessment is recommended for treatment individualization in old adults with diffuse large B-cell lymphoma (DLBCL). However, no specific assessment method to guide decision-making has been established yet. Here, we implement a therapeutic algorithm based on the information obtained in an updated comprehensive geriatric assessment (CGA) to assess the value that other prognostic factors add to frailty.

MATERIAL AND METHODS

We prospectively recruited 31 patients aged 70 or older recently diagnosed with DLBCL. Standard dose regimen R-CHOP and dose-attenuated R-miniCHOP were the therapeutic options. A CGA-based algorithm was used for the initial treatment recommendation. The sample was compared according to frailty and treatment allocation to describe baseline differential characteristics and treatment tolerance.

RESULTS

Mean age was 79 (SD: 5.5) and 45.1% were above 80. Half of the patients (51.6%) were frail; their survival was inferior to that observed in fit adults (p: .034). The mean Short Physical Performance Battery (SPPB) score of patients responding to therapy was higher than non-responders´ media (8.6 vs. 5.9; p: .022). However, when RCHOP was allocated to high functional patients within fit and frail groups, no differences in survival were found compared to R-miniCHOP. The prevalence of toxic events was higher with the standard regimen in fit (p: .054) and frail patients (p: 0.016).

CONCLUSIONS

The combination of frailty and physical performance assessment in an algorithm is a promising method to guide the decision-making process in old adults with DLBCL. SPPB might complete frailty predictive information on toxicity risk.

Hand grip strength, short physical performance battery, and gait speed: key tools for function in Non-Hodgkin Lymphoma

This study aimed to determine which performance assessment tools included in Comprehensive Geriatric Assessment (CGA) are the most sensitive for the functional approach in the initial evaluation and during the therapy of old adults diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL). We prospectively recruited 31 patients aged 70 years or older presenting for an initial consultation in the Hematology Clinic of a tertiary hospital. We implemented an updated physical performance evaluation as part of CGA at baseline and during treatment. Baseline characteristics of the sample were compared according to age, Geriatric 8 (G8), frailty, Short Physical Performance Battery (SPPB), and sarcopenia measured by hand grip strength (HGS). Functional changes were monitored during the treatment period using HGS, gait speed (GS) and SPPB. The mean age was 79.0 (5.5) years and 51.6% of the sample was frail; 65,5% were treated with standard chemotherapy and 35,5% with a therapeutic regimen with attenuated doses. All the assessment tools included in CGA found functional differences at baseline when the sample was stratified and compared according to frailty, sarcopenia, and SPPB, but not according to G8 score and age. Only SPPB was able to detect functional differences between groups stratified by age at baseline. GS was the only score that identified clinically significant functional changes during the treatment. In conclusion, HGS and SPPB are appropriate performance scores to complete the functional approach in the initial hematologic evaluation, and GS is a promising option to detect functional decline during therapy in old adults with DLBCL.

Lower-Limb Muscle Power Is Negatively Associated with Protein Intake in Older Adults: A Cross-Sectional Study

The present study examined the association between lower-limb muscle power and protein-related parameters in older adults. This study followed a cross-sectional design. Participants were community-dwelling older adults. Candidates were considered eligible if they were 60 years or older, lived independently, and possessed sufficient physical and cognitive abilities to perform all the measurements required by the protocol. The 5 times sit-to-stand (5STS) test was performed as fast as possible according to a standard protocol. Absolute, relative, and allometric muscle power measures were estimated using 5STS-based equations. Diet was assessed by 24-h dietary recall and diet composition was estimated using a nutritional software. One-hundred and ninety-seven older adults participated to the present study. After adjustment for covariates, absolute and allometric muscle power were negatively associated with body weight-adjusted protein intake. Our findings indicate that absolute and allometric muscle power estimated through a simple equation are negatively associated with body weight-adjusted protein intake in community-dwelling older adults.