Bouchardy Christine, Rapiti Elisabetta, Blagojevic Stina, Vlastos Anne-Thérèse, Vlastos Georges
Geneva Cancer Registry, Institute for Social and Preventive Medicine, Geneva University, Geneva, Switzerland.
J Clin Oncol. 2007 May 10;25(14):1858-69. doi: 10.1200/JCO.2006.10.4208.
Despite increased interest in treatment of senior cancer patients, older patients are much too often undertreated. This review aims to present data on treatment practices of older women with breast and gynecologic cancers and on the consequences of undertreatment on patient outcome. We also discuss the reasons and validity of suboptimal care in older patients. Numerous studies have reported suboptimal treatment in older breast and gynecologic cancer patients. Undertreatment displays multiple aspects: from lowered doses of adjuvant chemotherapy to total therapeutic abstention. Undertreatment also concerns palliative care, treatment of pain, and reconstruction. Only few studies have evaluated the consequences of nonstandard approaches on cancer-specific mortality, taking into account other prognostic factors and comorbidities. These studies clearly showed that undertreatment increased disease-specific mortality for breast and ovarian cancers. For other gynecological cancers, data were insufficient to draw conclusions. Objective reasons at the origin of undertreatment were, notably, higher prevalence of comorbidity, lowered life expectancy, absence of data on treatment efficacy in clinical trials, and increased adverse effects of treatment. More subjective reasons were putative lowered benefits of treatment, less aggressive cancers, social marginalization, and physician's beliefs. Undertreatment in older cancer patients is a well-documented phenomenon responsible for preventable cancer deaths. Treatments are still influenced by unclear standards and have to be adapted to the older patient's general health status, but should also offer the best chance of cure.
尽管对老年癌症患者的治疗越来越受关注，但老年患者往往治疗不足。本综述旨在呈现老年乳腺癌和妇科癌症患者的治疗实践数据，以及治疗不足对患者预后的影响。我们还将讨论老年患者治疗不充分的原因及合理性。众多研究报告了老年乳腺癌和妇科癌症患者存在治疗不充分的情况。治疗不足表现为多个方面：从辅助化疗剂量降低到完全放弃治疗。治疗不足还涉及姑息治疗、疼痛治疗和重建。只有少数研究在考虑其他预后因素和合并症的情况下，评估了非标准治疗方法对癌症特异性死亡率的影响。这些研究清楚地表明，治疗不足会增加乳腺癌和卵巢癌的疾病特异性死亡率。对于其他妇科癌症，数据不足以得出结论。治疗不足的客观原因主要包括合并症患病率较高、预期寿命降低、临床试验中缺乏治疗疗效数据以及治疗不良反应增加。更主观的原因包括推测治疗获益降低、癌症侵袭性较低、社会边缘化以及医生的观念。老年癌症患者治疗不足是一个有充分文献记载的现象，可导致可预防的癌症死亡。治疗仍受不明确标准的影响，必须根据老年患者的总体健康状况进行调整，但也应提供最佳的治愈机会。
