Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients
Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients
复制标题
DOI：
10.1016/j.critrevonc.2010.08.004
复制
发表时间：
2011-09-01
影响因子：
6.2
通讯作者：
Spano, Jean-Philippe
中科院分区：
文献类型：
--
作者：
Chaibi, Pascal;Magne, Nicolas;Spano, Jean-Philippe
老年患者代表了一个异质性的人群，在癌症治疗的决定往往是困难的。本研究的目的是报告一个为期2年的活动，老年评估咨询和治疗决策的影响。自2007年1月起，我们使用国际上广为人知的量表，对肿瘤科医生认为治疗决策较为复杂的老年患者进行了系统的老年科会诊。从2007年1月至2008年11月，共有161例患者（男性57例，女性104例;中位年龄82.4岁，范围73-97岁）接受了老年科会诊。大多数患者（134/161）正在接受一线治疗，86例患者（53%）的癌症转移。老年评估发现75例患者存在严重合并症（CIRS-G量表3级或4级），52例患者依赖至少一种日常生活活动（ADL），42例患者存在认知障碍，104例患者（65%）存在营养不良，39例患者存在抑郁症。根据肿瘤学家先前的决定，只有29名患者的治疗决定没有改变。79例患者（49%）改变了癌症治疗，包括5例患者延迟治疗，29例患者减少了强化治疗，45例患者增加了强化治疗。延迟做出最终决定或接受较低强度治疗的患者有更频繁的严重合并症（23/34，p
Elderly patients represent a heterogeneous population in which decisions on cancer treatment are often difficult. The present study aims to report a 2-year period of the activity of geriatric assessment consultations and the impact on treatment decisions. Since January 2007, we have systematically carried out geriatric consultations, using well-known international scales, for elderly patients in whom treatment decisions appear complex to oncologists.From January 2007 to November 2008, 161 patients (57 men, 104 women; median age 82.4 years, range 73-97) were seen at geriatric consultations. Most of the patients (134/161) were undergoing first-line treatment and cancer was metastatic in 86 patients (53%). Geriatric assessment found severe comorbidities (grade 3 or 4 in CIRS-G scale) in 75 patients, dependence for at least one activity of daily living (ADL) in 52 patients, cognitive impairment in 42 patients, malnutrition in 104 patients (65%) and depression in 39 patients. According to the oncologists' prior decisions, there were no changes in treatment decisions in only 29 patients. Cancer treatment was changed in 79 patients (49%), including delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45 patients. Patients for whom the final decision was delayed or who underwent less intensive therapy had significantly more frequent severe comorbidities (23/34, p