Jolly Trevor A, Deal Allison M, Nyrop Kirsten A, Williams Grant R, Pergolotti Mackenzi, Wood William A, Alston Shani M, Gordon Brittaney-Belle E, Dixon Samara A, Moore Susan G, Taylor W Chris, Messino Michael, Muss Hyman B
Hematology and Oncology Division and Center for Aging and Health/Division of Geriatric Medicine, School of Medicine, Lineberger Comprehensive Cancer Center, and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Rex Hematology Oncology Associates, Raleigh, North Carolina, USA; New Bern Cancer Care, New Bern, North Carolina, USA; Cancer Care of Western North Carolina (Affiliate of Mission Health), Asheville, North Carolina, USA
Hematology and Oncology Division and Center for Aging and Health/Division of Geriatric Medicine, School of Medicine, Lineberger Comprehensive Cancer Center, and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Rex Hematology Oncology Associates, Raleigh, North Carolina, USA; New Bern Cancer Care, New Bern, North Carolina, USA; Cancer Care of Western North Carolina (Affiliate of Mission Health), Asheville, North Carolina, USA.
Oncologist. 2015 Apr;20(4):379-85. doi: 10.1634/theoncologist.2014-0247. Epub 2015 Mar 12.
We investigated whether a brief geriatric assessment (GA) would identify important patient deficits that could affect treatment tolerance and care outcomes within a sample of older cancer patients rated as functionally normal (80%-100%) on the Karnofsky performance status (KPS) scale.
Cancer patients aged ≥65 years were assessed using a brief GA that included both professionally and patient-scored KPS and measures of comorbidity, polypharmacy, cognition, function, nutrition, and psychosocial status. Data were analyzed using descriptive statistics and multivariable logistic regression.
The sample included 984 patients: mean age was 73 years (range: 65-99 years), 74% were female, and 89% were white. GA was conducted before (23%), during (41%), or after (36%) treatment. Overall, 54% had a breast cancer diagnosis (n = 528), and 46% (n = 456) had cancers at other sites. Moreover, 81% of participants (n = 796) had both professionally and self-rated KPS ≥80, defined as functionally normal, and those patients are the focus of analysis. In this subsample, 550 (69%) had at least 1 GA-identified deficit, 222 (28%) had 1 deficit, 140 (18%) had 2 deficits, and 188 (24%) had ≥3 deficits. Specifically, 43% reported taking ≥9 medications daily, 28% had decreased social activity, 25% had ≥4 comorbidities, 23% had ≥1 impairment in instrumental activities of daily living, 18% had a Timed Up and Go time ≥14 seconds, 18% had ≥5% unintentional weight loss, and 12% had a Mental Health Index score ≤76.
Within this sample of older cancer patients who were rated as functionally normal by KPS, GA identified important deficits that could affect treatment tolerance and outcomes.
我们调查了简短老年医学评估（GA）能否在卡氏功能状态（KPS）量表评定为功能正常（80%-100%）的老年癌症患者样本中识别出可能影响治疗耐受性和护理结局的重要患者缺陷。
对年龄≥65岁的癌症患者使用简短GA进行评估，该评估包括专业人员评分和患者自评的KPS以及合并症、多种药物治疗、认知、功能、营养和心理社会状态的测量。使用描述性统计和多变量逻辑回归分析数据。
样本包括984例患者：平均年龄为73岁（范围：65-99岁），74%为女性，89%为白人。GA在治疗前（23%）、治疗期间（41%）或治疗后（36%）进行。总体而言，54%的患者诊断为乳腺癌（n = 528），46%（n = 456）的患者患有其他部位的癌症。此外，81%的参与者（n = 796）专业人员评分和自评的KPS均≥80，定义为功能正常，这些患者是分析的重点。在这个子样本中，550例（69%）至少有1项GA识别出的缺陷，222例（28%）有1项缺陷，140例（18%）有2项缺陷，188例（24%）有≥3项缺陷。具体而言，43%的患者报告每天服用≥9种药物，28%的患者社交活动减少，25%的患者有≥4种合并症，23%的患者日常生活工具性活动有≥1项受损，18%的患者计时起立行走时间≥14秒，18%的患者非故意体重减轻≥5%，12%的患者心理健康指数评分≤76。
在这个KPS评定为功能正常的老年癌症患者样本中，GA识别出了可能影响治疗耐受性和结局的重要缺陷。
