Welcome to Managing MDS. I am Dr. Ellen Ritchie. I am frequently asked “What factors should community providers consider when selecting therapy for older patients with high-risk MDS?” This can be a difficult question because in older patients, by virtue of age alone, you cannot really tell how active they are or how healthy they are. It is very important to actually thoroughly assess your patients. What sort of supportive apparatus do they have at home? Do they live with a family member? Do they have family members who live close by? Is there someone who can drive them to the hospital quickly if they develop a fever or need emergency care? You need to factor their comorbid illness. If they have multiple comorbid illnesses and are on multiple medications, what will the impact of adding additional treatment to MDS be on their other comorbid illness and medication interactions?
I also try and figure out how active my patients are. If my patient is a person who is in bed most of the time or is sitting in a chair most of the time and is relatively inactive, their overall response to therapy may be more difficult than patients who are in better shape. It is very, very important when you are selecting a patient to really get an idea of what their performance status is, and whether or not there is someone to help them with their day-to-day activity if it deteriorates while they are receiving therapy.
Lastly, I consider what is the cognitive state of my patient? It may be that a patient is actually very good at having a social interaction, but when you start asking them more concrete questions, you realize that they are cognitively impaired. I have done a study looking at the geriatric assessment in older patients who are MDS and AML patients at Cornell, and I found a trend toward inferior outcome in patients whose cognitive ability is below the mean. It is very important to determine whether or not your patient is slightly demented or even demented before starting therapy because it will definitely impact their outcome and impact whether or not they need full-time support in order to get through their treatment. Thank you for viewing this activity.