Mariano Caroline, Williams Grant, Deal Allison, Alston Shani, Bryant Ashley Leak, Jolly Trevor, Muss Hyman B
Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
Oncologist. 2015 Jul;20(7):767-72. doi: 10.1634/theoncologist.2015-0023. Epub 2015 Jun 1.
Geriatric assessment (GA) is an important tool for management of older cancer patients; however, GA research has been performed primarily in the outpatient setting. The primary objective of this study was to determine feasibility of GA during an unplanned hospital stay. Secondary objectives were to describe deficits found with GA, to assess whether clinicians recognized and addressed deficits, and to determine 30-day readmission rates.
The study was designed as an extension of an existing registry, "Carolina Senior: Registry for Older Patients." Inclusion criteria were age 70 and older and biopsy-proven solid tumor, myeloma, or lymphoma. Patients had to complete the GA within 7 days of nonelective admission to University of North Carolina Hospital.
A total of 142 patients were approached, and 90 (63%) consented to participation. All sections of GA had at least an 83% completion rate. Overall, 53% of patients reported problems with physical function, 63% had deficits in instrumental activities of daily living, 34% reported falls, 12% reported depression, 31% had ≥10% weight loss, and 12% had abnormalities in cognition. Physician documentation of each deficit ranged from 20% to 46%. Rates of referrals to allied health professionals were not significantly different between patients with and without deficits. The 30-day readmission rate was 29%.
GA was feasible in this population. Hospitalized older cancer patients have high levels of functional and psychosocial deficits; however, clinician recognition and management of deficits were poor. The use of GA instruments to guide referrals to appropriate services is a way to potentially improve outcomes in this vulnerable population.
Geriatric assessment (GA) is an important tool in the management of older cancer patients; however, its primary clinical use has been in the outpatient setting. During an unplanned hospitalization, patients are extremely frail and are most likely to benefit from GA. This study demonstrates that hospitalized older adults with cancer have high levels of functional deficits on GA. These deficits are under-recognized and poorly managed by hospital-based clinicians in a tertiary care setting. Incorporation of GA measures during a hospital stay is a way to improve outcomes in this population.
老年评估（GA）是管理老年癌症患者的一项重要工具；然而，GA研究主要是在门诊环境中进行的。本研究的主要目的是确定在计划外住院期间进行GA的可行性。次要目的是描述GA发现的缺陷，评估临床医生是否认识到并处理了这些缺陷，并确定30天再入院率。
本研究设计为现有登记系统“卡罗莱纳老年人：老年患者登记系统”的扩展。纳入标准为年龄70岁及以上且经活检证实为实体瘤、骨髓瘤或淋巴瘤。患者必须在非选择性入住北卡罗来纳大学医院的7天内完成GA。
共联系了142名患者，90名（63%）同意参与。GA的所有部分完成率至少为83%。总体而言，53%的患者报告存在身体功能问题，63%的患者在日常生活工具性活动方面存在缺陷，34%的患者报告有跌倒情况，12%的患者报告有抑郁症状，31%的患者体重减轻≥10%，12%的患者存在认知异常。医生对每种缺陷的记录比例在20%至46%之间。有缺陷和无缺陷患者转介至联合健康专业人员的比例无显著差异。30天再入院率为29%。
GA在该人群中是可行的。住院的老年癌症患者存在高水平的功能和心理社会缺陷；然而，临床医生对缺陷的认识和管理较差。使用GA工具来指导转介至适当的服务是一种潜在改善这一脆弱人群结局的方法。
老年评估（GA）是管理老年癌症患者的一项重要工具；然而，其主要临床应用一直是在门诊环境中。在计划外住院期间，患者极其虚弱，最有可能从GA中获益。本研究表明，住院的老年癌症患者在GA上存在高水平的功能缺陷。这些缺陷在三级医疗环境中未得到医院临床医生的充分认识和妥善管理。在住院期间纳入GA措施是改善这一人群结局的一种方法。
