Prospective clinical trial evaluating vulnerability and chemotherapy risk using geriatric assessment tools in older patients with lung cancer.
Prospective clinical trial evaluating vulnerability and chemotherapy risk using geriatric assessment tools in older patients with lung cancer.
复制标题
使用老年评估工具评估老年肺癌患者的脆弱性和化疗风险的前瞻性临床试验。
DOI：
10.1111/ggi.13781
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Isobe T.
中科院分区：
文献类型：
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作者：
Tsubata Y;Shiratsuki Y;Okuno T;Tanino A;Nakao M;Amano Y;Hotta T;Hamaguchi M;Okimoto T;Hamaguchi S;Kurimoto N;Nishiyama Y;Kimura T;Iwata H;Tsumoto S;Isobe T.
目标在日本，老年癌症患者的数量一直在增加。评估体能状态、认知功能和社会背景对于老年患者的治疗是必要的。本研究的目的是：（i）建立一个使用电子病历的评估系统； (ii)根据老年评估（GA）系统评分区分老年患者健康与脆弱或虚弱。方法我们将GA工具纳入我们的电子病历系统中，并对年龄≥65岁的新诊断肺癌患者进行综合评估。关于主要治疗的决定是在与临床团队协商后做出的，不受 GA 评分的指导。记录后续治疗和结果。结果共有100名患者完成了GA。平均年龄为 75 岁（范围 65-94 岁）。关于 GA 结果，63% 在综合老年评估 7 中呈阳性，在弱势老年人调查 13 中呈阳性，39% 在老年评估 8 中呈阳性，84% 在老年评估 8 中呈阳性。非标准治疗组 (n= 19) 中弱势患者的百分比（所有三项 GA 均呈阳性）显着高于标准治疗组 (n= 81； 78.9%vs21.0%,P< 0.001)。在接受标准治疗的弱势患者中，47% 由于毒性而停止化疗。即使根据 GA 评分认为患者易受伤害，化疗对于具有 EGFR 突变的患者也可能是安全的。结论我们证实了该系统的可行性。在老年癌症患者的决策过程中，GA 的组合有助于防止治疗不足或过度治疗。Geriatr Gerontol Int 2019； 19：1108-1111。
AimIn Japan, the number of older patients with cancer has been increasing. Assessment of performance status, cognitive function and social background is necessary for the treatment of older patients. The aims of the present study were: (i) to establish an evaluation system using electronic medical records; and (ii) to distinguish older patients as fit versus vulnerable or frail according to a geriatric assessment (GA) system score.MethodsWe incorporated GA tools in our electronic medical records system and carried out comprehensive assessments for patients with newly diagnosed lung cancer aged ≥65 years. The decision about primary treatment followed consultation with the clinical team and was not guided by GA scores. Subsequent treatment and outcomes were recorded.ResultsA total of 100 patients had completed GA. The average age was 75 years (range 65–94 years). Regarding GA results, 63% were positive on the Comprehensive Geriatric Assessment 7, 39% on the Vulnerable Elderly Survey‐13 and 84% on the Geriatric 8. The percentage of vulnerable patients (positive on all three GA) was significantly higher in the non‐standard therapy group (n= 19) than in the standard therapy group (n= 81; 78.9%vs21.0%,P< 0.001). Among vulnerable patients who received standard therapy, 47% discontinued chemotherapy as a result of toxicity. Even if a patient was considered vulnerable based on GA scores, chemotherapy is possibly safe for those withEGFRmutations.ConclusionsWe confirmed the feasibility of this system. During decision‐making for older patients with cancer, a combination of GA helps prevent undertreatment or overtreatment.Geriatr Gerontol Int 2019; 19: 1108–1111.