Extermann Martine, Meyer Julie, McGinnis Margaret, Crocker Theresa T, Corcoran Mary Beth, Yoder Jerry, Haley William E, Chen Hongbin, Boulware David, Balducci Lodovico
Senior Adult Oncology, H. Lee Moffitt Cancer Center, University of South Florida, 12902 Magnolia Drive, Tampa, FL 33612, USA.
Crit Rev Oncol Hematol. 2004 Jan;49(1):69-75. doi: 10.1016/s1040-8428(03)00099-4.
Studies of comprehensive geriatric assessment (CGA) have shown the importance of follow-up for effectiveness, but this has not been tested in an oncology clinic. In this pilot study, we enrolled 15 early breast cancer patients, aged 70 and older. They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner, dietitian, social worker, and pharmacist according to risk. Total follow-up was 6 months. Median age of evaluable patients was 79 years (range 72-87). Median number of comorbidities by Cumulative Index Rating Scale-Geriatric (CIRS-G) was 5 (3-9) at baseline. Ten patients were at pharmacological risk, five at psychosocial risk, and eight at nutritional risk. Patients presented on average six problems initially, and three new problems during follow-up. The intervention directly influenced oncological treatment in four cases. It ensured continuity/coordination of care in seven cases. Success rate in addressing problems was 87%. Mean Functional Assessment of Cancer Treatment-Breast (FACT-B) scores improved from 110.5 (S.D. 16.7) to 116.3 (S.D. 16.5) (t=0.025). Function and independence were maintained.
Older patients with early breast cancer have a high prevalence of comorbidity. A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting.
综合老年评估（CGA）研究已表明随访对于有效性的重要性，但这尚未在肿瘤门诊中得到验证。在这项试点研究中，我们纳入了15名70岁及以上的早期乳腺癌患者。他们每3个月接受一次多学科CGA，并由SAOP护士执业医师、营养师、社会工作者和药剂师根据风险进行结构化随访。总随访时间为6个月。可评估患者的中位年龄为79岁（范围72 - 87岁）。根据老年累积指数评定量表（CIRS - G），基线时合并症的中位数量为5（3 - 9）。10名患者存在药物风险，5名存在心理社会风险，8名存在营养风险。患者最初平均存在6个问题，随访期间出现3个新问题。该干预在4例中直接影响了肿瘤治疗。在7例中确保了护理的连续性/协调性。解决问题的成功率为87%。癌症治疗功能评估 - 乳腺癌（FACT - B）平均得分从110.5（标准差16.7）提高到116.3（标准差16.5）（t = 0.025）。功能和独立性得以维持。
老年早期乳腺癌患者合并症患病率高。进行随访的CGA有改善这些患者治疗和预后的潜力，且在学术肿瘤环境中是可行的。
