(NSO-05) Patient Perceptions of Frailty and its Assessment in those Living with Myeloma

Introduction: Multiple myeloma is an incurable cancer of the blood, predominantly affecting older adults. With an ageing population comes an increase in patients with multi-comorbidities, polypharmacy and other issues associated with ageing. Frailty is defined as a state of increased vulnerability to stressors due to a clinical decline in physiological reserves. It is recognised that the assessment of frailty is complex, existing frailty definition tools present challenges of subjectivity and a need for protracted clinical time. It is accepted that frailty needs to be defined in a personalised way. Existing literature lacks the perception of patients living with myeloma with regards to frailty. This study seeks to fill this gap.

Methods: This was a single centre pilot study undertaken at a UK haematology centre. 9 patients and a carer were recruited into a patient focus group by open invitation. The aim of the group was to explore perceptions of frailty, frailty assessment tools (IMGW and G8) and consider the use of medical technology in frailty assessment. Data was obtained via semi-structured group discussions, questionnaires and conducting the G8 screening tool and IMWG frailty assessments on participants. Data was analysed via thematic analysis.

Results: Responses around perceptions of frailty were categorised into 4 themes – physical restrictions, psychological wellbeing, social impact and treatment related issues. Physical restrictions had the most responses. Perceptions of frailty were explored at the meeting outset. No patients considered themselves frail pre diagnosis.  44.4% considered themselves as frail now. At the end of the session, after more detailed exploration of frailty, 100% thought they would be considered frail based on the IMWG and G8 screening tools. Objectively, the IMWG classified 6 (66.7%) as intermediate fitness and 2 (22.2%) as frail. The G8 screening tool identified 8 (88.89%) as requiring full geriatric evaluation.
 
Participant perceptions of the tools were entirely negative, largely owing to what participants felt was their ‘impersonal’ nature. Participants gave feedback on the positive and negative aspects of wearable monitoring devices, with 88.89% willing to wear a device.

Conclusions: Frailty is a relevant topic in myeloma, yet patient perspectives have not been explored. This study highlighted a clear and marked disparity between patient perceptions of frailty and how this links to existing frailty assessments. Mentioning the terminology 'frailty' provoked exclusively negative impressions and thought may be given to re-framing this area of medicine to improve concordance between patients and their care team. It is clear from the results we need to define frailty in a more personalised and accurate way, giving consideration to how medical technology can potentially play a role in increasing the accuracy of data. This was a small pilot study which will be expanded upon and explored further with larger patient groups.