Comprehensive Cancer Center, School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157, USA.
J Am Geriatr Soc. 2011 Oct;59(10):1837-46. doi: 10.1111/j.1532-5415.2011.03614.x. Epub 2011 Sep 13.
To test the feasibility and utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia (AML).
Prospective observational cohort study.
Single academic institution.
Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy.
Bedside GA was performed during inpatient exmination for AML. GA measures included the modified Mini-Mental State Examination; Center for Epidemiologic Studies Depression Scale; Distress Thermometer, Pepper Assessment Tool for Disability (includes self- reported activities of daily living (ADLs), instrumental ADLs, and mobility questions); Short Physical Performance Battery (includes timed 4-m walk, chair stands, standing balance); grip strength, and Hematopoietic Cell Transplantation Comorbidity Index.
Of 54 participants (mean age 70.8 ± 6.4) eligible for this analysis, 92.6% completed the entire GA battery (mean time 44.0 ± 14 minutes). The following impairments were detected: cognitive impairment, 31.5%; depression, 38.9%; distress, 53.7%; impairment in ADLs, 48.2%; impaired physical performance, 53.7%; and comorbidity, 46.3%. Most were impaired in one (92.6%) or more (63%) functional domains. For the 38 participants rated as having good performance status according to standard oncologic assessment (Eastern Cooperative Oncology Performance Scale score ≤1), impairments in individual GA measures ranged from 23.7% to 50%. Significant variability in cognitive, emotional, and physical status was detected even after stratification according to tumor biology (cytogenetic risk group classification).
Inpatient GA was feasible and added new information to standard oncology assessment, which may be important for stratifying therapeutic risk in older adults with AML.
测试在为急性髓系白血病（AML）接受化疗的老年患者中进行床边老年综合评估（GA）以检测多个老年领域损伤的可行性和实用性。
前瞻性观察队列研究。
单一学术机构。
年龄在 60 岁及以上、新诊断为 AML 且计划接受化疗的个体。
在 AML 住院检查期间进行床边 GA。GA 测量包括改良的简易精神状态检查；流行病学研究中心抑郁量表；痛苦温度计，胡椒残疾评估工具（包括自我报告的日常生活活动（ADL）、工具性 ADL 和移动问题）；简短体能表现电池（包括定时 4 米步行、椅子站立、站立平衡）；握力和造血细胞移植合并症指数。
在 54 名符合本分析条件的参与者（平均年龄 70.8 ± 6.4）中，92.6%完成了整个 GA 电池（平均时间 44.0 ± 14 分钟）。发现以下损伤：认知障碍，31.5%；抑郁，38.9%；痛苦，53.7%；ADL 损伤，48.2%；身体表现受损，53.7%；合并症，46.3%。大多数人在一个（92.6%）或更多（63%）功能领域受损。对于根据标准肿瘤评估（东部合作肿瘤学表现量表评分≤1）被评为表现良好的 38 名参与者，个体 GA 测量中的损伤范围为 23.7%至 50%。即使根据肿瘤生物学（细胞遗传学风险组分类）进行分层，也检测到认知、情绪和身体状况的显著差异。
住院 GA 是可行的，并为标准肿瘤学评估提供了新信息，这对于分层 AML 老年患者的治疗风险可能很重要。
