Cancer
Changes in frailty among older adults with chronic lymphocytic leukemia/small lymphocytic lymphoma Vanessa Siebert* Vanessa Slater Ryan Carnahan Brian Smith Michael O’Rorke Christopher Strouse Elizabeth Chrischilles
Background: Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) predominantly impacts older adults and many have comorbidities at diagnosis. Comorbidities and frailty are associated with inferior clinical outcomes; however, it is not known how a CLL/SLL diagnosis impacts the trajectory of patients’ frailty. We sought to assess how frailty changes after diagnosis for patients with CLL/SLL in comparison to people without cancer and to patients with follicular lymphoma (FL).
Methods: Using the Surveillance, Epidemiology, and End Results-Medicare data, we identified 36,775 patients with CLL/SLL, 220,643 people without cancer, and 20,874 patients with FL. Frailty was measured using Medicare claims to calculate a total score from the 16 Function-Related Indicators. Logistic regressions computed ORs and corresponding 95% CIs for baseline frailty and worsening of frailty in the 12-months after diagnosis and linear mixed effects models assessed change in frailty.
Results: Patients with CLL/SLL had higher baseline frailty compared to people without cancer (adjusted OR=1.20, 95% CI: 1.17-1.22) and patients with FL (adjusted OR=1.06, 95% CI: 1.03-1.10). Patients with CLL/SLL were more likely to have worsening of frailty in the 12-months after diagnosis (adjusted OR=2.21, 95% CI: 2.15-2.27) and had a higher rate of increase in frailty (adjusted βinteraction=0.02, 95% CI: 0.01-0.02) compared to people without cancer. In contrast, patients with CLL/SLL were less likely to have worsening of frailty in the 12-months after diagnosis (adjusted OR=0.75, 95% CI: 0.73-0.78), but had a higher rate of frailty development (adjusted βinteraction=0.02, 95% CI: 0.02-0.03) compared to patients with FL.
Conclusions: Patients with CLL/SLL and patients with FL experienced worsening frailty after diagnosis. Our study results support the continued need for clinical assessments for frailty and consideration of ways to mitigate worsening of frailty after a diagnosis of CLL/SLL or FL.