Hamaker Marije E, Prins Meike C, Schiphorst Anandi H, van Tuyl Sebastiaan A C, Pronk Apollo, van den Bos Frederiek
Diakonessenhuis Utrecht/Zeist/Doorn, Department of Geriatric Medicine, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
Department of Surgery, Diakonessenhuis Utrecht, The Netherlands.
J Geriatr Oncol. 2015 Mar;6(2):153-64. doi: 10.1016/j.jgo.2014.10.001. Epub 2014 Nov 6.
Older patients with colorectal cancer are faced with the dilemma of choosing between the short-term risks of treatment and the long-term risks of insufficiently treated disease. In addition to treatment-related morbidity and mortality, patients may suffer from loss of physical capacity. The purpose of this review was to gather all available evidence regarding long-term changes in physical functioning and role functioning after colorectal cancer treatment, by performing a systematic Medline and Embase search. This search yielded 27 publications from 23 studies. In 16 studies addressing physical functioning after rectal cancer treatment, a median drop of 10% (range -26% to -5%) in the mean score for this item at three months. At six months, mean score was still 7% lower than baseline (range -18% to 0%) and at twelve months 5% lower (range -13% to +5%). For role functioning (i.e. ability to perform daily activities) after rectal cancer treatment, scores were -18% (range -39% to -2%), -8% (range -23% to +6%) and -5% (range -17% to +10%) respectively. Elderly patients experience the greatest and most persistent decline in self-care capacity (up to 61% at one year). This systematic review demonstrates that both physical functioning and role functioning are significantly affected by colorectal cancer surgery. Although initial losses are recovered partially during follow-up, there is a permanent loss in both aspects of physical capacity, in patients of all ages but especially in the elderly. This aspect should be included in patient counselling regarding surgery.
老年结直肠癌患者面临着在治疗的短期风险和疾病治疗不充分的长期风险之间进行抉择的困境。除了与治疗相关的发病率和死亡率外，患者还可能出现身体功能丧失。本综述的目的是通过对Medline和Embase进行系统检索，收集所有关于结直肠癌治疗后身体功能和角色功能长期变化的现有证据。该检索共得到来自23项研究的27篇出版物。在16项关于直肠癌治疗后身体功能的研究中，该项目的平均得分在三个月时中位数下降了10%（范围为-26%至-5%）。在六个月时，平均得分仍比基线低7%（范围为-18%至0%），在十二个月时低5%（范围为-13%至+5%）。对于直肠癌治疗后的角色功能（即进行日常活动的能力），得分分别为-18%（范围为-39%至-2%）、-8%（范围为-23%至+6%）和-5%（范围为-17%至+10%）。老年患者的自我护理能力下降最为明显且持续时间最长（一年时高达61%）。这项系统综述表明，结直肠癌手术对身体功能和角色功能均有显著影响。尽管在随访期间初始损失会部分恢复，但在所有年龄段的患者中，尤其是老年患者，身体能力的这两个方面都存在永久性损失。这一方面应纳入患者关于手术的咨询中。
