Zeber John E, Copeland Laurel A, Hosek Brandon J, Karnad Anand B, Lawrence Valerie A, Sanchez-Reilly Sandra E
Department of Veterans Affairs, South Texas Veterans Health Care System (Verdict), HSR&D, San Antonio, TX 78229-4404, USA.
Crit Rev Oncol Hematol. 2008 Sep;67(3):237-42. doi: 10.1016/j.critrevonc.2008.02.002. Epub 2008 Mar 19.
Cancer disproportionately afflicts older patients, with 56% of incident diagnoses and 71% of deaths occurring in this population. Yet little is known about the "oldest of the old", oncology patients underrepresented in clinical trials. We examined elderly veterans diagnosed with lung, colorectal, prostate or head-neck cancer in 2005 (n=194,797), analyses comparing treatment receipt by age group, 70-84 versus 85-115. Treatment was more common among younger elders, including surgery (1.3% versus 0.6%), chemotherapy (2.1% versus 0.8%) and radiation (1.7% versus 0.7%). Differences were sharper for certain cancers, e.g., chemotherapy for lung (9.0% versus 2.9%), or colorectal surgery (5.8% versus 3.4%). Cancer prevalence is high among elders yet treatment rates appear extremely low, despite evidence of well-tolerated treatment. Toxicity concerns and comorbidities may inhibit pursuit of definitive treatment. As we reconcile definitions of 'elderly' with appropriate treatment options, compassionate care requires identifying geriatric oncology guidelines that improve survival and quality of life.
癌症对老年患者的影响尤为严重，56%的新发病例诊断以及71%的死亡病例都出现在这一人群中。然而，对于“最年长的老人”，即在临床试验中代表性不足的肿瘤患者，我们却知之甚少。我们研究了2005年被诊断患有肺癌、结直肠癌、前列腺癌或头颈癌的老年退伍军人（n = 194,797），分析比较了70 - 84岁和85 - 115岁年龄组的治疗接受情况。治疗在较年轻的老年人中更为常见，包括手术（1.3%对0.6%）、化疗（2.1%对0.8%）和放疗（1.7%对0.7%）。某些癌症的差异更为明显，例如肺癌化疗（9.0%对2.9%）或结直肠癌手术（5.8%对3.4%）。尽管有证据表明治疗耐受性良好，但老年人中的癌症患病率很高，而治疗率似乎极低。对毒性的担忧和合并症可能会抑制对确定性治疗的追求。当我们将“老年人”的定义与适当的治疗选择相协调时，富有同情心的护理需要确定能够提高生存率和生活质量的老年肿瘤学指南。
