Management of Frail and Not-Frail elderly cancer patients in a hospital-based geriatric oncology program
Management of Frail and Not-Frail elderly cancer patients in a hospital-based geriatric oncology program
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DOI：
10.1016/j.critrevonc.2007.12.006
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发表时间：
2008-05-01
影响因子：
6.2
通讯作者：
Monfardini, Silvio
中科院分区：
文献类型：
--
作者：
Basso, Umberto;Tonti, Singora;Monfardini, Silvio
目的：评估我们肿瘤内科病房收治的年龄为bb0 = 70岁的患者的管理和结果，并在接受标准或“老年人友好”化疗方案治疗前进行多维老年评估，我们的老年肿瘤项目根据已发表的临床试验和个人经验制定了一份清单。患者和方法：回顾2004年1月至2006年1月间治疗的患者的治疗选择、肿瘤反应、毒副反应和生存率。结果：117例患者（中位年龄75岁）分为虚弱(F)（34.2%）和非虚弱（NF: 33.3% Fit + 32.5% Vulnerable）。根据“老年人友好”化疗方案的使用（40%的F - pt和39%的NF - pt），剂量减少>= 25%（37.5%对31.2%）和3-4级毒性（52.5%对58.4%），两组没有差异。早期因毒性或患者拒绝而中断治疗（42.5 vs. 15.6, p = 0.001）和最后一次化疗后30天内死亡（22.5% vs. 3.9%, p = 0.003）有显著差异。F例患者在21.2%的病例中表现出临床或放射学反应，22.6%的患者主观改善。中位随访19个月后，F组患者的中位生存期（6.4个月）短于NF组（16.9个月，p = 0.012）。结论：“老年人友好型”化疗方案的使用仅限于不到一半的病例。F患者可能对化疗有反应，但与NF患者相比，F患者表现出更高的过早停药率和早亡率，生存期较短。迫切需要特别针对体弱患者的临床试验。2007爱思唯尔爱尔兰有限公司版权所有。
Purpose: To evaluate management and outcome of patients >= 70 years admitted to our Medical Oncology ward and evaluated by Multidimensional Geriatric Assessment before treatment with standard or "elderly-friendly" chemotherapy regimens, a list of which was developed within our Geriatric Oncology Program based on published clinical trials and personal experience.Patients and methods: Charts of patients treated from January 2004 to January 2006 were reviewed for choice of treatment, tumor response, toxicities and survival.Results: 117 patients (median age 75 years) were divided into Frail (F) (34.2%) and Not-Frail patients (NF: 33.3% Fit plus 32.5% Vulnerable). The two groups did not differ according to the use of "elderly-friendly"chemotherapy regimens (40% of F pts and 39% of NF pts), dose reductions >= 25% (37.5% vs. 31.2%) and grade 3-4 toxicities (52.5% vs. 58.4%). Early interruption of treatment due to toxicity or patient's refusal (42.5 vs. 15.6, p = 0.001) and deaths within 30 days from last chemotherapy administration (22.5% vs. 3.9%, p = 0.003) were significantly different. F patients showed clinical or radiological response in 21.2% of cases, and subjective improvement in 22.6%. After a median follow-up of 19 months, median survival of F patients (6.4 months) is shorter compared to NF group (16.9 months, p = 0.012).Conclusions: The use of "elderly-friendly"chemotherapy regimens was limited to less than a half of cases. F patients may respond to chemotherapy but display higher rates of premature withdrawal and early deaths compared to NF patients, with a shorter survival. Clinical trials particularly aimed at frail patients are urgently needed. (c) 2007 Elsevier Ireland Ltd. All rights reserved.