The early discontinuation of palliative chemotherapy in older patients with cancer
The early discontinuation of palliative chemotherapy in older patients with cancer
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DOI：
10.1007/s00520-013-2033-y
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发表时间：
2014-03-01
影响因子：
3.1
通讯作者：
Kim, Jee Hyun
中科院分区：
文献类型：
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作者：
Kim, Jin Won;Kim, Yu Jung;Kim, Jee Hyun
老年癌症患者早期停止积极治疗(ED)的风险可能会增加，这会导致在根治或辅助治疗环境中结果不佳。我们的目的是确定生存率和ED之间的关系，并确定姑息性环境中ED的预测因素。对98名在姑息一线化疗前接受综合老年评估(CGA)的65岁以上患者进行分析。临床信息和CGA结果从电子病历中检索。CGA包括Charlson并存指数、日常生活活动能力(ADL)、工具性ADL(IADL)、简易精神状态检查、简式老年抑郁量表、计时起身试验(TGUG)和简易营养评估(MNA)。ED的定义是除了姑息性一线化疗外，没有积极的癌症治疗(放疗和/或化疗)。使用临床参数和CGA确定ED的预测因素，在中位15.1个月的随访期内，30名患者在一线化疗后停止积极治疗。一线化疗后的勃起功能障碍患者的总生存期较短(OS；与非勃起功能障碍患者相比，中位OS=3.1月比14.7个月，p<；0.001)。东部合作肿瘤组表现状况、独居、日常生活能力、生活能力和生活能力与ED相关(p=0.001，p=0.048，p=0.001，p&t；0.001，p<；0.001，p=0.002)。在多变量分析中，营养不良和IADL依赖是ED的独立预测因素(优势比=5.03；95%可信区间=1.50~16.87；优势比=3.06；可信区间=1.03~9.12)。老年癌症患者的ED与较短的OS有关。营养不良和IADL依赖是ED的独立预测因素。
Older patients with cancer may have an increased risk of early discontinuation of active treatment (ED), which results in poor outcome in curative or adjuvant settings. We aimed to determine the association between survival and ED and to identify predictors of ED in palliative setting.Ninety-eight patients older than 65 years of age who received a comprehensive geriatric assessment (CGA) before palliative first-line chemotherapy were analyzed. Clinical information and CGA results were retrieved from electronic medical record. CGA included Charlson's co-morbidity index, activities of daily living (ADL), instrumental ADL (IADL), Mini-Mental Status Examination, short-form of the geriatric depression scale, timed-get-up-and-go test (TGUG), and mini-nutritional assessment (MNA). ED was defined as no active cancer treatment (radiotherapy and/or chemotherapy) beyond palliative first-line chemotherapy. Predictors of ED were identified using clinical parameters and CGA.Active treatment was discontinued after first-line chemotherapy in 30 patients during median follow-up period of 15.1 months. ED after first-line chemotherapy was associated with shorter overall survival (OS; median OS = 3.1 vs. 14.7 months in patients with ED compared with patients without ED, p < 0.001). Eastern Cooperative Oncology Group performance status, living alone, ADL, IADL, MNA, and TGUG were associated with ED (p = 0.001, p = 0.048, p = 0.001, p < 0.001, p < 0.001, p = 0.002, respectively). In multivariable analysis, malnutrition and dependent IADL were the independent predictive factors for ED (odds ratio = 5.03; 95 % confidence interval = 1.50-16.87: odds ratio = 3.06; confidence interval = 1.03-9.12, respectively).ED was associated with shorter OS in older patients with cancer. Malnutrition and dependent IADL were identified as independent predictive factors for ED.