• The Korean journal of internal medicine
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• v.39 no.3
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• pp.501-512
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• 2024

Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

• Science of Emotion and Sensibility
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• v.20 no.1
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• pp.95-104
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• 2017

This study aims to develop a reliable and valid Geriatric Reaction Inventory-Simplified Form (GRI-SF). Reaction inventory for measuring anger (Evans & Stangelang, 1971) is an assessment tool in a view of stimuli for measuring the level of anger invoked from the anger-triggered experiences. Yet, the inventory, comprised of 76 items, is sometimes incapable of finishing up the lengthy questionnaire. In the sense, a simplified form of RI is necessary for those lacks cognitive ability such as stroke patients or the elderly. In study 1, a full version of Reaction Inventory was given for the elder who are above 60, and ten items out of 76 was selected to form GRI-SF based on the psychometric theory. In study 2, the reliability and validity of GRI-SF was tested by another sample group of elderly with some additional examinations. The reliability was good with Cronbach's alpha of 0.79. Based on the fact that GRI-SF measures the personal trait anger, GRI-SF should not be only strong correlation with the scores of trait anger strongly, but be less correlated with scores representing other aspects of anger. As a result, GRI-SF score showed strong correlations with trait anger among other sub-categories of State-Trait Expression Inventory (STAXI), and was less correlated with anger-out score which reflects behavioral aspect of anger. Moreover, it is less correlated (r=.41) with hostility representing attitudinal or cognitive aspects of anger. Consequently, GRI-SF, constructed by this research, is verified to be a reliable and valid tool for anger measurement.