韩国老年癌症患者化疗中的综合老年评估。
Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy.
机构信息
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Korea.
出版信息
J Cancer Res Clin Oncol. 2011 May;137(5):839-47. doi: 10.1007/s00432-010-0945-1. Epub 2010 Sep 4.
BACKGROUND
Growing evidence suggests that a comprehensive geriatric assessment (CGA) in older patients with cancer can detect unsuspected health problems, predict survival, and predict tolerance to chemotherapy. However, studies regarding CGA in cancer patients are scarce in Asia.
METHODS
We prospectively enrolled 65 elderly cancer patients who were candidates of systemic chemotherapy between July 2006 and March 2008. Baseline CGA data including demographic information, comorbidity, functional status by means of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL), cognition, psychological state, nutritional status, and medication were collected and analyzed. Quality of life (QoL) was assessed by the EORTC questionnaire QLQ-C30.
RESULTS
Of the 65 patients, the median age was 71 years (range, 65-80), 49 (75%) were males, and 58 (89%) had Eastern Cooperative Oncology Group performance status (ECOG PS) 0 or 1. All patients had solid tumor, 74% received palliative chemotherapy, and 18% received adjuvant chemotherapy. Twenty-five percent of patients had Charlson's comorbidity index score of 2 or more, 23% were ADL dependent, and 14% were IADL dependent. Using Mini-Mental Status Exam (MMSE), it was found that 51% of patients had mild cognitive impairment (MMSE score 17-24), and 5% had cognitive impairment (≤ 16). Forty percent of patients had depression by Short form Geriatric Depression Scale (SGDS), 19% had malnutrition by Mini-Nutritional Assessment (MNA), and 23% had body mass index (BMI) less than 19.4 kg/m(2) (lowest 10%). Global health status/quality of life (QoL) was less than 50% in 39% of patients. Frail patients according to the Balducci classification had significantly poor ECOG PS and worse global health status/QoL.
CONCLUSION
CGA was feasible and could detect multiple unsuspected health problems including functional impairment and malnutrition in Korean elderly cancer patients receiving chemotherapy.
背景
越来越多的证据表明，对老年癌症患者进行全面的老年评估（CGA）可以发现未被察觉的健康问题，预测生存，并预测对化疗的耐受性。然而，亚洲关于癌症患者 CGA 的研究很少。
方法
我们前瞻性地招募了 65 名 2006 年 7 月至 2008 年 3 月期间接受全身化疗的老年癌症患者。收集并分析基线 CGA 数据，包括人口统计学信息、合并症、日常生活活动（ADL）的功能状态、工具性日常生活活动（IADL）、认知、心理状态、营养状况和药物治疗情况。采用 EORTC 问卷 QLQ-C30 评估生活质量（QoL）。
结果
65 例患者中，中位年龄为 71 岁（范围，65-80 岁），49 例（75%）为男性，58 例（89%）ECOG PS 为 0 或 1。所有患者均为实体瘤，74%接受姑息性化疗，18%接受辅助化疗。25%的患者Charlson 合并症指数评分≥2，23%的患者 ADL 依赖，14%的患者 IADL 依赖。使用简易精神状态检查（MMSE）发现，51%的患者有轻度认知障碍（MMSE 评分 17-24），5%的患者有认知障碍（≤16）。40%的患者采用简易老人抑郁量表（SGDS）有抑郁症状，19%采用微型营养评估（MNA）有营养不良，23%的患者 BMI＜19.4kg/m2（最低 10%）。39%的患者全球健康状况/生活质量（QoL）评分＜50%。根据 Balducci 分类，虚弱患者的 ECOG PS 明显较差，全球健康状况/QoL 更差。
结论
CGA 是可行的，可以发现接受化疗的韩国老年癌症患者的多种未被察觉的健康问题，包括功能障碍和营养不良。
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