Wedding Ulrich, Ködding Daphne, Pientka Ludger, Steinmetz Hans T, Schmitz Stefan
Department of Internal Medicine II, Division of Haematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany.
Crit Rev Oncol Hematol. 2007 Oct;64(1):1-9. doi: 10.1016/j.critrevonc.2007.05.001. Epub 2007 Jul 5.
Elderly cancer patients are a very heterogeneous population. A comprehensive geriatric assessment (CGA) shall help to identify more precisely those patients who are fit, compared to those who are vulnerable or frail, when deciding on chemotherapeutical treatment.
In a prospective trial, 200 cancer patients treated in an out-patient setting were judged by their physician for their fitness for chemotherapy as fit, vulnerable or frail. A CGA was performed thereafter. We determined the feasibility of a CGA in an out-patient setting and the frequency of changes within the different assessment tools and compared physicians' judgement with the CGA results.
Physicians judged 64.3% of their patients as fit, 32.4% as vulnerable, and 3.2% as frail. A CGA was completed by 97.5% of patients and lasted 20min per patients (range: 9-47min). 26.5% of all patients had no deficits in the CGA. The CGA identified a mean of 1.7 problems per patient, 1.3 in patients judged as fit, 2.3 in those judged as vulnerable, and 4.2 in those judged as frail. A CGA is more sensitive in classifying patients as fit compared to vulnerable or frail than physicians' judgement.
A CGA is feasible and detects more elderly cancer patients as being unfit for chemotherapy than physicians' judgement. Further trials including disease and treatment related end-points are needed.
老年癌症患者是一个非常多样化的群体。在决定化疗方案时，全面老年评估（CGA）有助于更准确地识别那些身体状况适合的患者，以及那些脆弱或虚弱的患者。
在一项前瞻性试验中，200名在门诊接受治疗的癌症患者由其医生评估化疗适合度，分为适合、脆弱或虚弱三类。之后进行了全面老年评估。我们确定了在门诊环境中进行全面老年评估的可行性以及不同评估工具中变化的频率，并将医生的判断与全面老年评估结果进行了比较。
医生将64.3%的患者判断为适合，32.4%为脆弱，3.2%为虚弱。97.5%的患者完成了全面老年评估，每位患者耗时20分钟（范围：9 - 47分钟）。所有患者中有26.5%在全面老年评估中无缺陷。全面老年评估发现每位患者平均存在1.7个问题，被判断为适合的患者为1.3个，被判断为脆弱的患者为2.3个，被判断为虚弱的患者为4.2个。与医生的判断相比，全面老年评估在将患者分类为适合而非脆弱或虚弱方面更敏感。
全面老年评估是可行的，并且与医生的判断相比，能发现更多不适合化疗的老年癌症患者。需要进一步开展包括疾病和治疗相关终点的试验。
