Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
J Natl Cancer Inst. 2012 Aug 8;104(15):1133-63. doi: 10.1093/jnci/djs285. Epub 2012 Jul 31.
Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult's medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality).
We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks.
We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10-45 min. Geriatric assessment was most often completed to describe a patient's health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%-50% of treatment decisions.
Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed.
老年评估是一种多学科的诊断过程，评估老年人的医疗、心理、社会和功能能力。目前尚未对肿瘤学中使用老年评估进行系统评价。本系统评价的目的是：1）概述所有用于肿瘤学的老年评估工具；2）检查这些工具的可行性和心理测量特性；3）系统评估老年评估在预测或改变结局方面的有效性（包括对治疗决策、治疗毒性和死亡率的影响）。
我们检索了 Medline、Embase、Psychinfo、Cinahl 和 Cochrane Library 中 1996 年 1 月 1 日至 2010 年 11 月 16 日期间发表的英文、法文、荷兰文或德文文献，报告评估老年评估工具可行性或有效性的横断面、纵向、干预或观察研究。使用相关的质量评估框架评估文章的质量。
我们确定了 83 篇报告了 73 项研究的文章。大多数研究的质量较差或中等。11 项研究检查了所使用的老年评估工具的心理测量特性或诊断准确性。评估通常需要 10-45 分钟。老年评估最常用于描述患者的健康和功能状态。在 9 项研究中的 6 项和在 16 项研究中的 8 项中，老年评估的特定领域与治疗毒性和死亡率相关。在 4 项检查老年评估对癌症治疗决策影响的研究中，有两项发现老年评估影响了 40%-50%的治疗决策。
肿瘤学中的老年评估是可行的，一些领域与不良结局相关。然而，有有限的证据表明老年评估影响了治疗决策。需要进一步研究老年评估对治疗决策和结局的有效性。
