Rodin Miriam B, Mohile Supriya G
Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
J Clin Oncol. 2007 May 10;25(14):1936-44. doi: 10.1200/JCO.2006.10.2954.
More than half of new cancers are diagnosed in elderly patients, but data from randomized clinical trials do not represent the elderly population. Comprehensive geriatric assessment (CGA) can contribute valuable information to oncologists for risk stratification of elderly cancer patients. Functional impairments, frailty markers, cognitive impairments, and physical disabilities increase the risk for adverse outcomes during cancer treatment. Evidence is accumulating that selected elderly cancer patients benefit from CGA and geriatric interventions. However, perceived barriers to CGA include time, familiarity, cost, and lack of a well-defined procedure to interpret and apply the information. We present a model for rapid selection of elderly who would benefit from CGA using screening tools such as the Vulnerable Elders-13 Survey. We also define important geriatric functional risk factors, including mobility limitation, frailty, and dementia, and demonstrate how brief screening tests can make use of data realistically available to clinical oncologists to determine a stage of aging. Summary tables and a decision tree demonstrate how these data can be compiled to determine the risk for toxicities and to anticipate ancillary support needs.
超过半数的新发癌症患者为老年患者，但随机临床试验的数据并不能代表老年人群体。综合老年评估（CGA）可为肿瘤学家对老年癌症患者进行风险分层提供有价值的信息。功能障碍、衰弱标志物、认知障碍和身体残疾会增加癌症治疗期间出现不良结局的风险。越来越多的证据表明，部分老年癌症患者可从CGA和老年干预措施中获益。然而，CGA存在的一些障碍包括时间、熟悉程度、成本以及缺乏解释和应用信息的明确程序。我们提出了一种使用诸如“脆弱老年人-13调查”等筛查工具快速筛选出能从CGA中获益的老年人的模型。我们还定义了重要的老年功能风险因素，包括行动受限、衰弱和痴呆，并展示了简短的筛查测试如何利用临床肿瘤学家实际可获取的数据来确定衰老阶段。汇总表和决策树展示了如何整理这些数据以确定毒性风险并预测辅助支持需求。
