St James' Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds.
Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Ann Oncol. 2015 Jun;26(6):1091-1101. doi: 10.1093/annonc/mdu540. Epub 2014 Nov 17.
Frailty is a state of vulnerability to poor resolution of homeostasis following a stressor event, such as chemotherapy or cancer surgery. Better knowledge of the epidemiology of frailty could help drive a global cancer care strategy for older people. The aim of this review was to establish the prevalence and outcomes of frailty and pre-frailty in older cancer patients.
Observational studies that reported data on the prevalence and/or outcomes of frailty in older cancer patients with any stage of solid or haematological malignancy were considered. We searched Medline, CINAHL, Cochrane Library, EMBASE, Web of Science, Allied and Complementary medicine, Psychinfo and ProQuest (1 January 1996 to 30 June 2013). The primary outcomes were prevalence of frailty, treatment-related side-effects, unplanned hospitalization and mortality. Risk of bias was assessed using the Newcastle-Ottawa checklist.
Data from 20 studies evaluating 2916 participants are included. The median reported prevalence of frailty and pre-frailty was 42% (range 6%-86%) and 43% (range 13%-79%), respectively. A median of 32% (range 11%-78%) of patients were classified as fit. Frailty was independently associated with increased all-cause mortality [adjusted 5-year hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.36-2.57]. There was evidence of increased risk of postoperative mortality for both frailty (adjusted 30-day HR 2.67, 95% CI 1.08-6.62) and pre-frailty (adjusted HR 2.33, 95% CI 1.20-4.52). Treatment complications were more frequent in those with frailty, including intolerance to cancer treatment (adjusted odds ratio 4.86, 95% CI 2.19-10.78) and postoperative complications (adjusted 30-day HR 3.19, 95% CI 1.68-6.04).
More than half of older cancer patients have pre-frailty or frailty and these patients are at increased risk of chemotherapy intolerance, postoperative complications and mortality. The findings of this review support routine assessment of frailty in older cancer patients to guide treatment decisions, and the development of multidisciplinary geriatric oncology services.
衰弱是一种在应激事件后，对内环境稳定的分辨率下降的脆弱状态，例如化疗或癌症手术。更好地了解衰弱的流行病学情况可能有助于推动全球老年人癌症护理策略。本综述的目的是确定老年癌症患者衰弱和衰弱前期的患病率和结局。
考虑了报告任何阶段实体或血液恶性肿瘤的老年癌症患者衰弱和衰弱前期患病率和/或结局数据的观察性研究。我们检索了 Medline、CINAHL、Cochrane 图书馆、EMBASE、Web of Science、辅助和补充医学、心理信息和 ProQuest（1996 年 1 月 1 日至 2013 年 6 月 30 日）。主要结局是衰弱的患病率、治疗相关副作用、非计划性住院和死亡率。使用纽卡斯尔-渥太华检查表评估偏倚风险。
纳入了 20 项评估 2916 名参与者的研究的数据。报告的衰弱和衰弱前期的中位数患病率分别为 42%（范围 6%-86%）和 43%（范围 13%-79%）。中位数 32%（范围 11%-78%）的患者被归类为健康。衰弱与全因死亡率增加独立相关[调整后的 5 年危险比（HR）1.87，95%置信区间（CI）1.36-2.57]。衰弱（调整后 30 天 HR 2.67，95% CI 1.08-6.62）和衰弱前期（调整后 HR 2.33，95% CI 1.20-4.52）均有术后死亡风险增加的证据。在患有衰弱的患者中，治疗并发症更为常见，包括对癌症治疗不耐受（调整后的优势比 4.86，95% CI 2.19-10.78）和术后并发症（调整后的 30 天 HR 3.19，95% CI 1.68-6.04）。
超过一半的老年癌症患者存在衰弱前期或衰弱，这些患者有更高的化疗不耐受、术后并发症和死亡率风险。本综述的研究结果支持对老年癌症患者常规评估衰弱，以指导治疗决策，并发展多学科老年肿瘤学服务。
