Marinello Renata, Marenco Daniela, Roglia Daniela, Stasi Maria Francesca, Ferrando Alberto, Ceccarelli Manuela, Bertetto Oscar, Molaschi Mario, Ciccone Giovannino
Department of Medical and Surgical Science, Section of Gerontology, University of Turin, Corso Bramante, Turin, Italy.
Arch Gerontol Geriatr. 2009 Mar-Apr;48(2):222-6. doi: 10.1016/j.archger.2008.01.011. Epub 2008 Mar 11.
Several instruments have been proposed to improve treatment decisions in elderly cancer patients, but evidence of their impact in clinical practice is limited. The aim of this study was to analyze the role of clinical and functional factors in predicting serious adverse events, including death, severe toxicity or treatment interruption, during chemotherapy in elderly cancer patients. The survey evaluated elderly with lung or colon or breast cancer treated with chemotherapy, followed by S. Giovanni Battista Hospital. We enrolled 110 consecutive patients older than 70 years of age with lung (n=45), colon (n=50) and breast (n=15) cancer between October 2004 and October 2005. Overall, 73/110 patients (66.4%) experienced adverse events as death (n=14), grades III and IV toxicity (n=40), or treatment interruption for other reasons (n=19). The variables with stronger predictivity were advanced stage, toxicity of treatment, level of comorbidity and Karnofsky performance status (KPS). instrumental activities of daily living (IADL) index and age itself were not independent predictors. In conclusion our results confirm the need of a careful selection of elderly patients suitable for chemotherapy, giving more weight to comorbidity and KPS scores than to age itself. The potential role of other functional evaluations need to be further assessed in randomized controlled trials.
已有多种工具被提出来改善老年癌症患者的治疗决策，但它们在临床实践中的影响证据有限。本研究的目的是分析临床和功能因素在预测老年癌症患者化疗期间严重不良事件（包括死亡、严重毒性或治疗中断）中的作用。该调查评估了在圣乔瓦尼·巴蒂斯塔医院接受化疗的老年肺癌、结肠癌或乳腺癌患者。我们在2004年10月至2005年10月期间连续纳入了110例年龄超过70岁的肺癌（n = 45）、结肠癌（n = 50）和乳腺癌（n = 15）患者。总体而言，110例患者中有73例（66.4%）经历了不良事件，如死亡（n = 14）、III级和IV级毒性（n = 40）或因其他原因中断治疗（n = 19）。预测性较强的变量为晚期、治疗毒性、合并症水平和卡氏功能状态评分（KPS）。日常生活活动能力（IADL）指数和年龄本身并非独立预测因素。总之，我们的结果证实需要谨慎选择适合化疗的老年患者，相较于年龄本身，应更重视合并症和KPS评分。其他功能评估的潜在作用需要在随机对照试验中进一步评估。
