Managing Frailty in Myeloma Patients: Assessment and Tools

Corinne Farrow Myeloma/MGUS Clinical Nurse Specialist University Hospitals of Leicester NHS Trust

Frailty within Clinical Practice How to manage frailty How to assess frailty and what tools can be used Now what? How can healthcare professionals use information about patient frailty in their clinical practice? How can we use the information to facilitate shared-decision making? How can this aid the delivery of person-centred, holistic care?

Why is it important? We can tailor treatment to each individual patient Maintain or even improve quality of life Limit toxicity of treatment Reduce admission rates and length of stay Control costs (Kosolvo et al., 2019) AND STILL Offer an effective treatment which aims to controls the patient's myeloma Ensure that patients are neither over nor under treated

(Taken from Morrow et al., 2021)

How we use frailty assessments In Outpatient Clinics Strong suspicion of MM or ASMM based of medical assessment of symptoms and biochemical markers Starting new line of treatment Gain consent Consider frailty assessment for all patients aged 65 and over Consider for patients aged less than 65 with continuous support needs or multi-morbidity All patients aged 80 and over

What do we need to ask ourselves? What is the patient's baseline? Has this changed? Is the patient fit enough for invasive investigations? Does the patient have a history of frequent hospital admissions? Could the patient's frailty be attributed to Myeloma or other health condition?

Assessments ECOG CFS (Rockwood et al., 2005) Abbreviated Mental Test Score (AMTS) (Hodkinson, 1972) IMWG International Myeloma Working Group, Geriatric Assessment (Palumbo et al., 2015) Comorbidity Functional Status Automatic score of 2 for patients aged 80 and over Timed Up and Go Normally informal as you need equipment and allocated space to do assessment > 20 seconds

How the information is used ECOG, CFS and IMWG frailty scores documented in notes Consultant letter contain ECOG +/- CFS Letters from clinic and CNS documentation are used in MDT Formal ECOG, CFS, IMWG documented on MDT outcomes Allows healthcare professionals to easily identify changes in patient s overall health Allows on going assessment of patient s frailty and attenuate treatment accordingly Requires co-ordinated MDT involvement

Identification of unmet needs ADLS Signposting to social services, support needs assessment, care resource eligibility or environmental home safety assessment Tissue viability pressure area advice, GP involvement, TVN or district nursing referral Activity/exercise PT/OT referral, charity and community classes, complementary therapies, Myeloma UK exercise booklet Nutritional status Prescription from clinic, signposting to local/charity services, referral to dietician, written information Cognitive assessment Primary care assessment and referral, Admiral nursing, local and national charities

Identification of unmet needs Mood/depression PHQ-9 and GAD-7, referral to local psychology or counseling services, input from GP, local or national charity services Transport hospital transport information, hospital car parking, Blue Badge, local charity services Tele-health & mHealth Hospital Ambulatory Care services, LTC monitoring, remote medication management, wellness/fitness apps Supportive and Palliative Care Services Community phlebotomy

Considerations for clinical practice Improved patient experience from patient experience questionnaires Improved patient understanding and shared decision making Enables independence, encourages accountability The initial CNS time and resource output results in shorter consultations for CNS and Consultants later Required undertaking QIP with follow up after 1 year of implementation (Quality Improvement Project) Requires full MDT/stakeholder involvement Can be used for data gathering Could be applied to other services within Haematology and Oncology Foundation for further service development and improvement

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