Functional Decline in Older Patients With Cancer Receiving First-Line Chemotherapy
Functional Decline in Older Patients With Cancer Receiving First-Line Chemotherapy
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DOI：
10.1200/jco.2012.47.7430
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发表时间：
2013-11-01
影响因子：
45.3
通讯作者：
Soubeyran, Pierre
中科院分区：
文献类型：
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作者：
Hoppe, Stephanie;Rainfray, Muriel;Soubeyran, Pierre
PurposeTo确定与早期功能下降一线化疗在老年patients.Patients和MethodsPatients年龄>= 70岁接受一线化疗的癌症前瞻性地考虑在法国的12个中心纳入相关因素。功能下降定义为从化疗开始到第二个周期，日常生活活动（ADL）量表评分下降≥ 0.5分。从治疗前的简易综合老年评估（包括ADL、工具性ADL（IADL）、简易营养评估（MNA）、简易精神状态检查（MMSE）、老年抑郁量表（GDS 15）和定时起床和行走（GUG）测试）以及合并症中寻找与功能下降相关的因素（累积疾病评定量表，老年），MAX2指数，和基线生物和临床information.ResultsOf 364包括患者，50经历了功能下降（16.7%，中位数，0.5点）。入院前体能状态、IADL、GDS 15、MMSE、GUG和MNA异常与功能下降的可能性增加相关（单变量分析）。在校正基线ADL和MAX2指数的多变量模型中，高基线GDS（比值比[OR]，2.16; 95% CI，1.09至4.30; P = .03）和低IADL评分（OR，2.87; 95% CI，1.06 ~ 7.79; P = .04）与功能下降风险增加独立相关。结论我们的结果概述了基线抑郁症，工具依赖，以及老年患者化疗期间的早期功能下降。ADL应在治疗早期进行连续评估。可建议对GDS 15和IADL进行基线评价，以预测该事件。(C)2013年美国临床肿瘤学会
PurposeTo determine factors associated with early functional decline during first-line chemotherapy in older patients.Patients and MethodsPatients age >= 70 years receiving first-line chemotherapy for cancer were prospectively considered for inclusion across 12 centers in France. Functional decline was defined as a decrease of >= 0.5 points on the Activities of Daily Living (ADL) scale between the beginning of chemotherapy and the second cycle. Factors associated with functional decline were sought from pretreatment abbreviated comprehensive geriatric assessment, including ADL, Instrumental ADL (IADL), Mini-Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS15), and Timed Get Up and Go (GUG) test, and from comorbidities (Cumulative Illness Rating Scale-Geriatrics), MAX2 index, and baseline biologic and clinical information.ResultsOf 364 included patients, 50 experienced functional decline (16.7%; median, 0.5 points). Abnormal preadmission performance status, IADL, GDS15, MMSE, GUG, and MNA were associated with increased likelihood of functional decline (univariate analysis). In the multivariate model adjusted for baseline ADL and MAX2 index, high baseline GDS (odds ratio [OR], 2.16; 95% CI, 1.09 to 4.30; P = .03) and low IADL scores (OR, 2.87; 95% CI, 1.06 to 7.79; P = .04) were independently associated with increased risk of functional decline.ConclusionOur results outline associations between baseline depression, instrumental dependencies, and early functional decline during chemotherapy for older patients. ADL should be sequentially evaluated early during treatment. Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event. (C) 2013 by American Society of Clinical Oncology