Frailty and Cancer: Implications for Oncology Surgery, Medical Oncology, and Radiation Oncology
Frailty and Cancer: Implications for Oncology Surgery, Medical Oncology, and Radiation Oncology
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DOI：
10.3322/caac.21406
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发表时间：
2017-10-01
影响因子：
254.7
通讯作者：
Master, Viraj A.
中科院分区：
文献类型：
--
作者：
Ethun, Cecilia G.;Bilen, Mehmet A.;Master, Viraj A.
脆弱的概念已经越来越被认为是医疗保健和健康结果中最重要的问题之一，对于正在接受手术、化疗和放射治疗的癌症患者来说尤其重要。由于癌症本身以及所提供的治疗方法都可能是挑战患者生理储备的重大额外应激源，因此老年癌症患者的虚弱发生率尤其高--据估计，超过一半的老年癌症患者有虚弱或易感。然而，对脆弱的定义可能具有挑战性。简而言之，脆弱是一种极易受到压力的状态，这种压力会导致不利的健康后果。事实上，脆弱是一种复杂的、多维的、周期性的生理储备减少的状态，导致弹性和适应能力降低，对应激源的脆弱性增加。此外，还提出了70多种不同的脆弱性措施。尽管如此，已经证明虚弱的患者术后并发症、化疗不耐受、疾病进展和死亡的风险增加。尽管脆弱临界点需要国际标准化，但肿瘤内科医生和外科医生继续努力识别脆弱并促进多学科决策将有助于制定更个性化的管理策略，并优化对癌症患者的护理。(C)2017年美国癌症协会。
The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes. In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors. In addition, over 70 different measures of frailty have been proposed. Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. (C) 2017 American Cancer Society.