Velghe A, Noens L, Demuynck R, De Buyser S, Petrovic M

Hand grip strength as a screening tool for detection of older patients with haematological malignancies who would benefit from a comprehensive geriatric assessment

Velghe A, Noens L, Demuynck R, De Buyser S, Petrovic M.

Introduction: Cancer is primarily a disease of older people. With older age, there is an accumulation of impairments in multiple physiological systems, resulting in a decrease in physiological reserves and functional status. Frailty is a geriatric syndrome characterized by decreased physiological reserves and an age-related vulnerability to stressors resulting in a higher risk of adverse health outcomes. One tool to detect frailty in older patients is the Comprehensive Geriatric Assessment (CGA). A CGA however is time-consuming, requiring the use of a screening tool (two-step approach). The G8 is a screening tool validated in older patients with haematological malignancies to detect those frail patients in need of a CGA. Few screening tools however include physical/functional measures. The use of simple performance tests provides objective results and is feasible in busy clinical practice. Hand grip strength (HGS) measures skeletal muscle function in the upper extremities and is one of the best indicators of the overall strength of the limb. Handgrip dynamometry is known to be a valid and reliable tool to represent total body muscle strength. Studies indicate that cancer patients, compared with healthy controls, have significant impairments in muscle strength, regardless of disease stage. No studies are available on the use of HGS as a screening tool to detect patients in need of a CGA.

Objectives: The aim of this study was to assess whether HGS can be used as a screening tool to detect those patients that would benefit from a CGA.

Methods: Patients, 70 years or older, with a new diagnosis of Acute Myeloid Leukaemia, intermediate or high grade

Myelodysplastic Syndrome, Multiple Myeloma or high grade Non Hodgkin Lymphoma, referred to the haematology department of a tertiary hospital, were enrolled in the current study. Before the start of therapy, CGA and G8 were completed for each patient. CGA was considered abnormal when a patient received an impaired score on at least one questionnaire. HGS was measured by a Martin vigorimeter. The highest score of 3 consecutive trials with the dominant hand was retained. Measures are expressed in kilopascals (kPa). ROC-curve analysis was used to determine inherent validity of HGS. The study was approved by the local Ethical Committee.

Results: Complete results were obtained for 59 patients.

Median HGS was 52.3 ± 20.0 kPa. HGS was significantly higher in patients with a normal CGA compared to those with an abnormal CGA (68.7 kPa ±19.8 vs. 50.1 kPa ± 19.1; p=0.019). In the analysis of the association between HGS and the reference CGA, the ROC curve revealed a HGS of ≤ 52 kPa (p <0.05) for women and ≤ 80 kPa (p<0.01) for men as the optimal cut-off point. AUC was 0.800 (95% CI 0.607 – 0.926) for women and 0.847 (95% CI 0.673 – 0.950) for men. Compared with the G8 screening tool, patients with higher hand grip strength have lower odds of having an abnormal G8 score. In women, mean HGS is 48.7 kPa ± 14.4 in patients with a normal G8, compared to 33.8 kPa ± 12.8 in patients with an abnormal G8 (p= 0.021). In men, the difference in HGS (72.4 ± 14.8 vs. 64.3 ± 12.3) between patients with normal and abnormal G8-score did not reach statistical significance.

Conclusion: Our results show that HGS, at a cut-off of 52 kPa for women and 80 kPa for men, can be used as a valid screening tool for older patients with aggressive haematological malignancies who would benefit from CGA.