Gait Speed May Improve Treatment Decisions in Elderly With Cancer

M. Alexander Otto, PA, MMS

December 18, 2020

Gait speed testing might improve decisions about treatment intensity for people 75 years or older with blood cancer, say researchers.

"The additional information this simple clinical test reveals about survival may help patients and physicians avoid inappropriately intensive or nonintensive treatment," say the authors, led by hematologist/oncologist Andrew Hantel, MD, at the Dana-Farber Cancer Institute, Boston, Massachusetts.

Their study was published online November 25 in the journal Cancer.

Dr Andrew Hantel

Oncologists have been searching for a quick, objective way to improve decisions about treatment intensity for older patients amid ever increasing options for hematologic cancers, the authors comment. The goal is a geriatric assessment to supplement performance status, disease characteristics, gestalt impressions, and other commonly used factors to better avoid overtreatment and undertreatment.

The National Institutes of Health's 4-meter gait speed test has been emerging in the literature as a likely candidate. It's a surrogate for physical function that seems to capture vulnerabilities missed by standard assessments. It takes about a minute to perform and requires no more than a tape measure and a stopwatch.

Dana-Farber researchers have previously shown that gait speed independently predicts survival in older adults with leukemia, myeloma, or lymphoma. The new results show that it retains its predictive power on multivariable analysis when limited to patients undergoing treatment, even when different treatment intensities are available under National Comprehensive Cancer Network (NCCN) guidelines.

The team also found that adding gait speed to age, cancer type, initial treatment, and other baseline covariates modestly improves survival prediction, whereas adding frailty assessments does not.

Gait Speed Not Taken Into Consideration

In this study, gait speed was assessed and the results were reported to the patients' oncologists after they had already made their treatment decisions.

The team evaluated gait speed in 782 patients 75 years or older who had blood cancer, but focussed their attention on 408 patients who required treatment and for whom different intensities of treatment were available per NCCN guidelines.

Among this subgroup of 408 patients, the treating physicians recommended standard intensity for 36.8% of the patients, reduced intensity for 54.9%, and supportive care for 8.3%.

However, there was no correlation between the gait speed and these treatment decisions; in fact, the results suggest there was a mismatch, at least for slower walkers. They show that 20 patients (4.9%) with the slowest gait speeds (0.6 meters per second or less) were recommended for standard intensity treatment, while reduced intensity or supportive care were recommended for 99 patients (24.3%) with the highest gait speeds (>0.8 m/s).

Among the faster subjects, reduced intensity or supportive care might simply have been patient preference, among other scenarios, Hantel said in an interview.

Gait speed is not currently considered by treating oncologists, but the researchers argue that it should be.

"Hematologic oncologists may benefit from having gait speed data at the time when treatment intensity decisions are considered," the team says, as it "could provide additional discriminatory value at the time of treatment choice."  

The investigation is ongoing. The next step is to see if providing gait speed information to treating oncologists changes intensity recommendations and, more importantly, if it improves outcomes.

The work was funded by the National institutes of health and Dana-Farber Murphy Family Fund. Hantel has disclosed no relevant financial relationships.

Cancer. Published online November 25, 2020. Abstract

M. Alexander Otto is a physician assistant with a master's degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape, including McClatchy and Bloomberg. He is an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com

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