Maas Huub A A M, Janssen-Heijnen Maryska L G, Olde Rikkert Marcel G M, Machteld Wymenga A N
Department of Geriatric Medicine, Tweesteden Hospital, P.O. Box 90107, 5000 LA, Tilburg.
Eur J Cancer. 2007 Oct;43(15):2161-9. doi: 10.1016/j.ejca.2007.08.002. Epub 2007 Sep 12.
Comprehensive geriatric assessment (CGA) is a process that consists of a multidimensional data-search and a process of analyzing and linking patient characteristics creating an individualized intervention-plan, carried out by a multidisciplinary team. In general, the positive health care effects of CGA are established, but in oncology both CGA and the presence of geriatric syndromes still have to be implemented to tailor oncological therapies to the needs of elderly cancer patients. In this paper the conceptualization of geriatric syndromes, their relationship to CGA and results of clinical studies using CGA in oncology are summarized. Geriatric syndromes are associated with increased vulnerability and refer to highly prevalent, mostly single symptom states (falls, incontinence, cognitive impairment, dizziness, immobility or syncope). Multifactorial analysis is common in geriatric syndromes and forms part of the theoretical foundation for using CGA. In oncology patients, we reviewed the value of CGA on the following endpoints: recognition of health problems, tolerance to chemotherapy and survival. Most studies performed CGA to identify prognostic factors and did not include an intervention. The ability of CGA to detect relevant health problems in an elderly population is reported consistently but no randomized studies are available. CGA should explore the pre-treatment presence of (in)dependence in Instrumental Activities of Daily Living (IADL), poor or moderately poor quality of life, depressive symptoms and cognitive decline, and thereby may help to predict survival. However, if scored by the Charlson comorbidity-index, comorbidities are not convincingly related to survival. The few studies that included a CGA-linked intervention show inconsistent results with regard to survival but compared to usual care quality of life is improved in the surviving period. Functional performance scores and dependency at home appeared to be independent predictive factors for toxicity, similar to depressive symptoms and polypharmacy. Overall, CGA implements/collects information additional to chronological age and Performance Score. So far in oncology there are no prognostic validation studies reported using geriatric syndromes or information based on CGA in its decision making strategies.
综合老年评估（CGA）是一个由多学科团队开展的过程，包括多维数据搜索以及分析和关联患者特征以制定个性化干预计划的过程。总体而言，CGA的积极医疗保健效果已得到证实，但在肿瘤学领域，CGA和老年综合征的存在仍需落实，以便根据老年癌症患者的需求调整肿瘤治疗方案。本文总结了老年综合征的概念、其与CGA的关系以及在肿瘤学中使用CGA的临床研究结果。老年综合征与脆弱性增加相关，指的是高度普遍的、大多为单一症状的状态（跌倒、失禁、认知障碍、头晕、行动不便或晕厥）。多因素分析在老年综合征中很常见，是使用CGA的理论基础的一部分。在肿瘤患者中，我们评估了CGA在以下终点方面的价值：健康问题的识别、化疗耐受性和生存率。大多数研究进行CGA是为了识别预后因素，并未包括干预措施。一致报道了CGA在老年人群中检测相关健康问题的能力，但尚无随机研究。CGA应探索日常生活工具性活动（IADL）中（不）独立的治疗前存在情况、生活质量差或中等程度差、抑郁症状和认知衰退，从而可能有助于预测生存率。然而，如果用Charlson合并症指数评分，合并症与生存率的关系并不令人信服。少数纳入CGA相关干预措施的研究在生存率方面显示出不一致的结果，但与常规护理相比，生存期的生活质量有所改善。功能表现评分和在家中的依赖程度似乎是毒性的独立预测因素，类似于抑郁症状和多重用药。总体而言，CGA实施/收集的信息除了 chronological age和Performance Score之外。到目前为止，在肿瘤学领域，尚无使用老年综合征或基于CGA的信息在其决策策略中的预后验证研究报告。
