Assessing the value of measuring frailty in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.

PURPOSE: Most patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) have comorbidities at diagnosis, which are associated with worse outcomes. Despite its clinical relevance, frailty is understudied in CLL/SLL. Our study examined the contributions of frailty, measured with Function-Related Indicators (FRIs), and comorbidity for assessing health status in patients with newly diagnosed CLL/SLL. METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified 30,880 older patients with CLL/SLL. FRI score and the National Cancer Institute (NCI) Comorbidity Index were calculated using claims in the year before diagnosis. Hazard ratios (HRs) for mortality and hospitalization were assessed with Cox hazards models. RESULTS: Frailty and comorbidity were common prior to diagnosis: 48.6% of patients had ≥ 1 FRI, 64.8% had ≥ 1 condition in the NCI Comorbidity Index, and 27.4% had prior or simultaneous cancer. People with more FRIs (i.e., frailer) were older, more likely to be female and unmarried, had more comorbidities, and were more likely to have been hospitalized in the 12-months prior to CLL/SLL diagnosis. The FRI remained predictive after adjusting for comorbidity and patients with higher baseline frailty had an increased risk of mortality (FRI ≥2 vs 0: adjusted HR = 1.37, 95% CI: 1.31-1.43) and hospitalization (FRI ≥2 vs 0: adjusted HR = 1.34, 95% CI: 1.29-1.40). CONCLUSIONS: Different aspects of health status were identified by the FRI and comorbidity. Assessing frailty at diagnosis, when many patients have not yet experienced extensive disease-related symptoms, adds independently to predicting patient outcomes beyond comorbidity alone.