Date Presented 04/21/2023
This study identified unique OT needs of older adults with acute myeloid leukemia (AML) receiving oral venetoclax and infusional hypomethalating agent (VEN + HMA) therapy. A battery of tests performed on 19 older adults in the early stages of chemotherapy suggest that grip strength and mobility decline and the need for more nuanced evaluation of cognition. We found careful evaluation was important to understand cognitive and physical impairments in the context of meaningful occupational challenges.
Primary Author and Speaker: Farrell Leigh Wiggins
Additional Authors and Speakers: Alexis Petteway
Contributing Authors: Mackenzi Pergolotti, Todd Schwartz, Zachary Ripberger, Susan Coppola, Ashley Bryant, Ya-Ning Chan
PURPOSE: To better understand the occupational therapy needs of adults with AML during cycle 1 for treatment of oral Venetoclax (VEN) and Infusional Hypomethylating Agent (HMA). Occupational therapy services for older adults with cancer are recognized to address functional and occupational needs. Access to these services is severely limited and underutilized.
DESIGN: Prospective inception cohort trial (Clinicaltrial.gov #NCT04570709).
METHOD: Possibilities for Activity Scale (PActS), Activity Measure in Post-Acute Care (AM-PAC) mobility and activities of daily living (ADL) scales, Performance Rate Assessment of Self-Care Skills (PASS, medication management and hand hygiene task), clock-drawing, Timed Up and Go (TUG), and Berg Balance Scale, hand-grip strength.
RESULTS: Patients (N = 20) were 74.7 ± 7.5 years, (range: 64–89), predominantly male (n = 15, 75 %), White (n = 18, 90%) and with some college education (n = 11, 55%). Average PActS score 43, (range 29–60), AM-PAC ADL raw scores (23.4 mean, 1.3SD, 19–24) and mobility (19.7 mean, 0.7 SD, 17–20), PASS hand hygiene and medication management, both average of 3 (range 1–3), clock drawing (n = 18) average of 12.5 (0.07 SD, 11–13), TUG average 13.1 (4.2SD, 6.6–21.0), Berg average 49.7 (5.9SD, range 39.0–56.0), average grip strength (Non-Dominant 44.6 (10–79.7); Dominant 48.7 (range 17–81.7).
CONCLUSION: Gaps in occupational therapy services for older adults with cancer call for data on needs of this population. This study demonstrated the need for occupational therapy services in early phases of chemotherapy to addresses a range of functional needs of these clients. However, based on these findings alone, we recognized a need for more detailed assessment on cognitive decline and meaningful occupations. Future studies will include more in-depth assessments with these needs in mind.
IMPACT STATEMENT: Up to 70 percent of all cancer survivors will be over the age of 65 in 2040, representing a large majority of cancer survivors, yet, knowledge of their needs is largely unknown because they are excluded from most cancer trials. This study has a powerful influence on occupational therapy by demonstrating the need for occupational therapy services in cancer care for policy makers and provides evidence of unmet needs of this vulnerable population.
References
Pergolotti, M., Lyons, K. D., & Williams, G. R. (2018). Moving beyond symptom management towards cancer rehabilitation for older adults: Answering the 5W’s. Journal of Geriatric Oncology, 9(6), 543–549.
Alfano, C. M., & Pergolotti, M. (2018). Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabilitation Nursing Journal, 43(4), 186–194.
Lyons, K. D., Padgett, L. S., Marshall, T. F., Greer, J. A., Silver, J. K., Raj, V. S., . . . & Alfano, C. M. (2019). Follow the trail: using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation. CA: a cancer journal for clinicians, 69(2), 113–126.
