Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada.
Am J Clin Oncol. 2012 Aug;35(4):322-8. doi: 10.1097/COC.0b013e318210f9ce.
A comprehensive geriatric assessment (CGA) is an objective means of assessing the global health of older patients. While evidence suggesting its promise in improving outcome prediction in the oncology setting is growing, its benefit in guiding treatment decisions remains uncertain. We sought to determine the feasibility and impact of CGA, from a consultative geriatric-oncology service, on treatment decisions in older cancer patients.
A pilot clinic, where patients underwent CGA with a medical oncologist and geriatrician, was established. Patients ≥70 years, with gastrointestinal or lung cancer were eligible. Following standard assessment by the primary oncologist, a treatment decision was recorded. Patients subsequently underwent a CGA. The final treatment plan was made by the primary oncologist after receipt of findings and recommendations from the CGA. Changes in treatment decisions were recorded.
The study enrolled from January to October 2009. Of 168 eligible patients, 120 (71%) were not referred for assessment. Thirty of 48 patients approached underwent CGA. In six patients the treatment plan was undecided at time of referral. In five of these, CGA impacted the ultimate decision (83%). Where the management plan was decided at time of referral (n=24), CGA impacted the final decision in only 1 patient (4%). Previously unidentified medical problems were identified in 70% of patients.
Several factors limited the feasibility of a consultation-type geriatric-oncology service to assess older cancer patients. The impact of CGA in informing treatment decisions was modest but may be of value when the initial treatment decision is uncertain.
全面老年评估（CGA）是评估老年患者整体健康状况的客观手段。尽管越来越多的证据表明它在改善肿瘤学环境下的预后预测方面具有潜力，但它在指导治疗决策方面的益处仍不确定。我们试图确定咨询老年肿瘤学服务中的 CGA 的可行性及其对老年癌症患者治疗决策的影响。
设立了一个试点诊所，让患者接受医学肿瘤学家和老年病学家的 CGA。年龄≥70 岁，患有胃肠道或肺癌的患者符合条件。在主要肿瘤学家进行标准评估后，记录治疗决策。随后，患者接受 CGA。在收到 CGA 的发现和建议后，主要肿瘤学家制定最终治疗计划。记录治疗决策的变化。
该研究于 2009 年 1 月至 10 月进行。在 168 名符合条件的患者中，有 120 名（71%）未被推荐进行评估。48 名患者中有 30 名接受了 CGA。在 6 名转诊时治疗计划尚未确定的患者中，CGA 影响了最终决策（83%）。在转诊时决定管理计划的患者（n=24）中，CGA 仅影响最终决策 1 例（4%）。在 70%的患者中发现了以前未识别的医疗问题。
有几个因素限制了咨询式老年肿瘤学服务评估老年癌症患者的可行性。CGA 在告知治疗决策方面的影响是适度的，但在初始治疗决策不确定时可能具有价值。
