Frailty May Impact Hospital Stay Duration After Stem Cell Transplants

As an aging population, frailty is a concern when patients are being considered for or undergoing stem cell transplant, and researchers at the Cleveland Clinic sought to examine this link.

Investigators, including Kayla Giannetti, MSN, APRN-CNP, who presented the findings at the 2024 Transplantation and Cellular Therapy Tandem Meetings, assessed cognitive function, physical abilities, and nutritional status of 137 adult patients between December 2021 and September 2023. "Frailty" was defined based on specific criteria like cognitive decline, slow walking speed, or recent falls. They then compared outcomes between "frail" and "not frail" groups.

While "frailty" was linked to older age, lower performance scores, and higher disease risk, it did not significantly affect whether patients could undergo the transplant, the pretransplant risk score, or the long-term survival rates. However, frail patients did have a longer average hospital stay after the transplant (26 days vs 24 days). The study also found no significant link between frailty and other factors like readmission rate, physical therapy need, or falls during hospitalization.

These findings suggest that frailty may be associated with a longer hospital stay for patients undergoing stem cell transplants at the Cleveland Clinic. However, the sample size was limited, and further research with larger cohorts is needed to confirm these findings. Additionally, future studies could explore the link between frailty and other outcomes, such as graft-vs-host disease, and investigate the role of psychosocial factors in frailty assessments.

Here, Giannetti discusses the rationale for the study and its implications for community oncologists.

Transcription:

0:05 | We're an aging population. We also have a population that has increasing comorbidities. These factors do increase frailty, are associated with frailty. Having had a lot of treatment prior to transplant for disease also increases rates and is associated with frailty. This kind of poses the important question, you know, does being a frail person necessarily mean that that should limit your ability to have a potentially life-saving, curative option for your disease? That really inspired me and a lot of other people to really start thinking about outcomes in their associated association with frailty and kind of target those areas and really think about that question, that very important question very deeply.

0:52 | Overall, the only significant finding that we found was length of stay for frail patients was significantly longer than nonfrail patients. I do want to mention that it's going to be really important to have a bigger cohort because our sample size was on the smaller side to really kind of investigate those subtleties in frailty and how they're associated with outcomes.

1:15 | I would really encourage the community oncologists to do start thinking about these interventions early on. I think that the earlier we think about interventions, the less frail people get. And it can even improve people's frailty in order to be able to potentially, you know, have this life-saving potential curative option. And also, really, there's studies like, there's all kinds of evidence and research that's coming out, that shows us what frailty looks like and there are tools being developed, like the Charm tool was recently developed that was presented [the 2024 American Society of Hematology Annual Meeting]. I would highly encourage community oncologists to evaluate and utilize these tools, including even with referral for transplant. There are a lot of patients who we once thought were not transplant-eligible that actually may be transplant-eligible. And with increased referrals to transplant, we're going to have more patients being able to transplant including older and aging population of patients.