How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study
How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study
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DOI：
10.1016/j.jgo.2019.04.006
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发表时间：
2019-11-01
影响因子：
3
通讯作者：
van Leeuwen, Barbara L.
中科院分区：
文献类型：
--
作者：
Festen, Suzanne;Kok, Maaike;van Leeuwen, Barbara L.
随着越来越多的证据表明老年癌症患者的老年评估（GA）结果预测的附加价值，问题从进行GA是否有用转变为如何以可行和有效的方式将其纳入标准实践。实施GA的效果，以及由肿瘤-老年多学科小组（MDT）评估患者对治疗建议的偏好，与肿瘤委员会先前提出的建议（照旧治疗）进行了比较。方法：年龄在70岁及以上的实体恶性肿瘤患者被转诊到三级保健中心接受诊断和治疗建议，由肿瘤委员会提供。干预包括：在肿瘤治疗开始前由护士主导的GA和对患者偏好的评估，在肿瘤-老年MDT中讨论这一点，并以结构化的、逐步的方式权衡所有这些信息。由这个肿瘤-老年MDT制定的治疗建议与肿瘤委员会的治疗建议进行了比较。结果：在236例符合条件的患者中，纳入了197例。27%的患者，老年肿瘤MDT的治疗建议与肿瘤委员会制定的建议不同。这些修改主要是针对不那么强化的治疗或姑息治疗。13%的患者随后被转介给老年病专家，以获得治疗建议。讨论：实施肿瘤-老年护理轨迹，使用遗传算法和患者偏好评估，导致四分之一的患者调整治疗建议。13%的人随后需要转诊给老年病专家。(C) 2019 Elsevier Ltd.版权所有。
Introduction: With the accumulating evidence on the added value on prediction of outcomes of geriatric assessment (GA) in older patients with cancer, the question shifts from whether performing a GA is useful, to how to implement this into standard practice in a feasible and effective way. The effect of implementing GA, and assessment of patient preferences on treatment recommendations by an onco-geriatric multidisciplinary team (MDT), was compared to the recommendation previously made by the tumor board (care as usual).Methods: Patients aged 70 years and older with a solid malignancy who were referred to a tertiary care center for diagnosis and treatment recommendations, as provided by a tumor board, were included. The intervention consisted of: a nurse-led GA and assessment of patient preferences prior to the start of oncological treatment, discussing this in an onco-geriatric MDT, and weighing all this information in a structured, stepwise manner. Treatment recommendations formulated by this onco-geriatric MDT were compared to the treatment recommendations by the tumor board.Results: Of 236 eligible patients, 197 were included. For 27%, treatment recommendations from the oncogeriatric MDT differed from the recommendations formulated by the tumor board. These modifications were mostly towards less intensive curative or palliative treatment. Thirteen percent of patients were subsequently referred to a geriatrician in order to reach a treatment recommendation.Discussion: Implementing an onco-geriatric care trajectory, using GA and assessment of patient preferences, resulted in an adjustment of treatment recommendations for a quarter of patients. Thirteen percent needed subsequent referral to a geriatrician. (C) 2019 Elsevier Ltd. All rights reserved.