Can older cancer patients tolerate chemotherapy? A prospective pilot study
Can older cancer patients tolerate chemotherapy? A prospective pilot study
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DOI：
10.1002/cncr.11110
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发表时间：
2003-02-15
期刊：
影响因子：
6.2
通讯作者：
Extermann, M
中科院分区：
文献类型：
--
作者：
Chen, HB;Cantor, A;Extermann, M
背景：据作者所知，目前关于老年癌症患者对化疗的耐受性的数据很少。这项前瞻性试点研究评估了接受化疗的老年肿瘤患者在功能、精神、营养和合并症状况以及生活质量（QOL）方面的变化。
方法：在一所大学附属的综合癌症中心招募了60名年龄≥70岁正在接受癌症化疗的患者。身体功能的变化通过东部肿瘤协作组体能状态（ECOG PS）和日常生活活动能力量表（IADLs）进行测量，精神健康变化通过简易精神状态检查表和老年抑郁量表（GDS）进行测量，合并症通过查尔森指数和累积疾病评定量表 - 老年版进行测量，营养状况通过微型营养评定进行测量，生活质量通过癌症治疗功能评估 - 通用版（FACT - G）进行测量。在基线和治疗结束（EOT）时评估变化。记录4级血液学毒性和3 - 4级非血液学毒性。
结果：37名患者（63%）完成了两项评估。老年癌症患者在接受化疗后身体功能的测量指标显著下降，这体现在IADL评分（P = 0.04）以及FACT - G的身体（P = 0.01）和功能（P = 0.03）分量表评分的变化上。他们在化疗后进行的GDS评分也更差（P < 0.01）。经历严重化疗毒性的患者在ECOG PS（P = 0.03）、IADL（P = 0.03）和GDS（P = 0.04）方面的下降更显著，并且在FACT - G的社会福祉分量表上的得分增加更明显（P = 0.02），而未经历严重化疗毒性的患者则不然。然而，大多数评分的变化在临床上幅度较小。在营养、合并症以及FACT - G的其他方面，基线和EOT之间未发现显著变化。
结论：接受化疗的老年癌症患者可能会出现毒性反应，但一般能够耐受，对独立性、合并症和生活质量水平的影响有限。在老年肿瘤治疗过程中认识和监测这些变化是很重要的。
BACKGROUND. To the authors' knowledge, few data currently are available regarding the tolerance to chemotherapy in older cancer patients. This prospective pilot study evaluated the changes in functional, mental, nutritional, and comorbid status, as well as the quality of life (QOL), in geriatric oncology patients receiving chemotherapy.METHODS. Sixty patients age greater than or equal to 70 years who were undergoing cancer chemotherapy were recruited in a university-based comprehensive cancer center. Changes in physical function were measured by the Eastern Cooperative Oncology Group performance status (ECOG PS) and Instrumental Activities of Daily Living (IADLs), mental health changes were measured by the Mini-Mental State Examination and the Geriatric Depression Scale (GDS), comorbidity was measured by Charlson's index and the Cumulative Illness Rating Scale-Geriatric, nutrition was measured by the Mini-Nutritional Assessment, and QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Changes were assessed at baseline and at the end of treatment (EOT). Grade 4 hematologic and Grade 3-4 nonhematologic toxicities were recorded.RESULTS. Thirty-seven patients (63%) completed both assessments. Older cancer patients demonstrated a significant decline in measurements of physical function after receiving chemotherapy, as indicated by changes in scores on the IADL (P = 0.04) and on the physical (P = 0.01) and functional (P = 0.03) subscales of the FACT-G. They also displayed worse scores on the GDS administered postchemotherapy (P < 0.01). Patients who experienced severe chemotoxicity had more significant declines in ECOG PS (P = 0.03), IADL (P = 0.03), and GDS (P = 0.04), and more gain in the social well-being subscale (P = 0.02) of the FACT-G, than those who did not experience severe chemotoxicity. However, changes in most scores were small in magnitude clinically. No significant change was found between baseline and EOT in nutrition, comorbidity, and other aspects of the FACT-G.CONCLUSIONS. Older cancer patients undergoing chemotherapy may experience toxicity but generally can tolerate it with limited impact on independence, comorbidity, and QOL levels. It is important to recognize and monitor these changes during geriatric oncology treatment.