Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Semin Radiat Oncol. 2012 Oct;22(4):265-71. doi: 10.1016/j.semradonc.2012.05.002.
Cancer is a prevalent disease in elderly patients, who are also more likely to have comorbid illnesses than younger patients. Both increasing age and comorbidities are associated with a lower use of aggressive cancer therapies-including surgery, chemotherapy, and radiation therapy-but age is often the stronger determinant. A large proportion of elderly but otherwise healthy cancer patients do not receive aggressive treatments. Although there is an underrepresentation of elderly patients in clinical trials, the available evidence suggests that elderly patients can derive similar survival benefits from aggressive treatments as younger patients. For certain cancers and treatments, elderly patients may experience higher rates of toxicity and therefore require closer monitoring. Patients with comorbid illnesses have worse health-related quality of life at baseline but experience a similar health-related quality of life decline from treatment as healthier patients. However, patients with significant comorbidities are less likely to derive benefit from aggressive treatments. There is a need for studies to better identify, at baseline, patients who are likely to benefit from and tolerate aggressive treatment. A systematic use of sophisticated assessments, such as the geriatric assessment, may allow physicians to select appropriate patients and reduce underutilization of aggressive treatments in elderly cancer patients.
癌症是老年患者中常见的疾病，与年轻患者相比，老年患者更容易同时患有多种疾病。年龄的增长和合并症的存在都与侵袭性癌症治疗（包括手术、化疗和放疗）的应用减少有关，但年龄往往是更强的决定因素。很大一部分身体状况良好但年龄较大的癌症患者并未接受侵袭性治疗。尽管临床试验中老年人患者的代表性不足，但现有证据表明，与年轻患者相比，老年患者可以从侵袭性治疗中获得相似的生存获益。对于某些癌症和治疗方法，老年患者可能会经历更高的毒性反应，因此需要更密切的监测。患有合并症的患者在基线时的健康相关生活质量较差，但与健康患者一样，他们在治疗过程中健康相关生活质量会下降。然而，患有严重合并症的患者不太可能从侵袭性治疗中获益。因此，需要进行研究以更好地在基线时识别出可能从侵袭性治疗中获益和耐受的患者。系统地使用复杂的评估方法，如老年评估，可能使医生能够选择合适的患者，并减少老年癌症患者中侵袭性治疗的未充分利用。
