Institute of Mental Health, GGZ-Delfland, Delft, the Netherlands.
Crit Rev Oncol Hematol. 2011 Aug;79(2):205-12. doi: 10.1016/j.critrevonc.2010.05.009. Epub 2010 Aug 14.
Comprehensive geriatric assessment (CGA) gives useful information on the functional status of older cancer patients. However, its meaning for a proper selection of elderly patients before chemotherapy and, even more important, the influence of chemotherapy on the outcome of geriatric assessment is unknown.
202 cancer patients, for whom an indication for chemotherapy was made by the medical oncologist, underwent a GA before start of chemotherapy by Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Index (GFI) and Mini Mental State Examination (MMSE). After completion of a minimum of four cycles of chemotherapy or at 6 months after the start of chemotherapy the GFI and MMSE assessment was repeated.
Frailty was shown in 10% of patients by means of MMSE, 32% by MNA, 37% by GFI and in 15% by IQCODE. Compared to patients who received 4 or more cycles of chemotherapy, the MNA and MMSE scores were significantly lower for patients treated with less than 4 cycles (p = 0.001 and p = 0.04 respectively). The mortality rate after start of chemotherapy was increased for patients with low MNA and high GFI scores with hazard ratios of 2.19 (95% confidence interval [CI]: 1.42-3.39; p < 0.001) and 1.80 (95% CI: 1.17-2.78; p = 0.007), respectively. After adjusting for sex, age, purpose of chemotherapy and type of malignancy these hazard ratios remained significant (p < 0.001 and p = 0.004), respectively. Finally, for the 51 patients who underwent repeated post-chemotherapy evaluation by GFI and MMSE, a statistically significant deterioration for the MMSE (p = 0.041) was found but not for the GFI.
Both inferior MNA and MMSE scores increased the probability not to complete chemotherapy. Also, an inferior score for MNA and GFI showed an increased mortality risk after the start of chemotherapy. The mean MMSE score worsened significantly during chemotherapy.
综合老年评估（CGA）可提供有关老年癌症患者功能状态的有用信息。然而，它对于化疗前选择老年患者的意义，甚至更重要的是，化疗对老年评估结果的影响尚不清楚。
对 202 名癌症患者进行了 CGA，这些患者的医学肿瘤学家建议进行化疗，化疗前通过 Mini Nutritional Assessment（MNA）、老年认知障碍知情问卷（IQCODE）、格罗宁根虚弱指数（GFI）和 Mini Mental State Examination（MMSE）进行评估。在完成至少 4 个周期的化疗后或化疗开始后 6 个月，再次评估 GFI 和 MMSE。
10%的患者通过 MMSE、32%的患者通过 MNA、37%的患者通过 GFI 和 15%的患者通过 IQCODE 表现出虚弱。与接受 4 个或更多周期化疗的患者相比，接受少于 4 个周期化疗的患者的 MNA 和 MMSE 评分明显较低（p = 0.001 和 p = 0.04）。化疗开始后，MNA 评分低和 GFI 评分高的患者死亡率增加，危险比分别为 2.19（95%置信区间[CI]：1.42-3.39；p <0.001）和 1.80（95%CI：1.17-2.78；p = 0.007）。在校正性别、年龄、化疗目的和恶性肿瘤类型后，这些危险比仍然具有统计学意义（p <0.001 和 p = 0.004）。最后，对于 51 名接受重复化疗后 GFI 和 MMSE 评估的患者，发现 MMSE 评分明显恶化（p = 0.041），但 GFI 无明显变化。
MNA 和 MMSE 评分较低均增加了无法完成化疗的可能性。此外，MNA 和 GFI 评分较低的患者在化疗开始后死亡风险增加。在化疗期间，MMSE 的平均评分明显恶化。
