Schiphorst A H W, Ten Bokkel Huinink D, Breumelhof R, Burgmans J P J, Pronk A, Hamaker M E
Department of Colorectal Surgery, Diakonessenhuis, Utrecht, the Netherlands.
Department of Medical Oncology, Diakonessenhuis, Utrecht, the Netherlands.
Eur J Cancer Care (Engl). 2016 May;25(3):365-70. doi: 10.1111/ecc.12349. Epub 2015 Jul 24.
Treatment decisions for elderly cancer patients can be challenging. A geriatric assessment may identify unknown medical conditions, give insight on patients' ability to tolerate treatment and guide treatment decisions. Our aim was to study the value of a geriatric consultation in oncological decision-making. Data on cancer patients referred for geriatric consultation for clinical optimisation or due to uncertainty regarding their optimal treatment strategy were prospectively analysed. Outcome of geriatric evaluations, non-oncological interventions and suggested adaptations of oncological treatment proposals were evaluated. Seventy-two patients were referred for consultation, over half of which in a curative treatment setting. Prevalence of geriatric syndromes was 93%, previously undiagnosed conditions were identified in 49% of patients and non-oncological interventions were initiated in 56%. Time was spent discussing patients' priorities (53% of consultations), expectations on treatment (50%) and advance care planning (14%). For 82% of patients, suggestions were made regarding the optimal treatment decision: a more intensive treatment was recommended in 39%, a less intensive therapy for 42% and in 19% only supportive care was suggested. The results demonstrate that a geriatric consultation can aid in complex treatment decisions and may allow for a reduction in over- and undertreatment of elderly cancer patients.
老年癌症患者的治疗决策颇具挑战性。老年评估或许能识别出未知的医疗状况，洞察患者耐受治疗的能力，并指导治疗决策。我们的目的是研究老年会诊在肿瘤治疗决策中的价值。对因临床优化或最佳治疗策略存疑而转诊进行老年会诊的癌症患者数据进行了前瞻性分析。评估了老年评估的结果、非肿瘤干预措施以及对肿瘤治疗方案建议的调整。72名患者被转诊进行会诊，其中半数以上处于根治性治疗阶段。老年综合征的患病率为93%，49%的患者被查出有此前未诊断出的病症，56%的患者开始了非肿瘤干预措施。会诊时间用于讨论患者的优先事项（53%的会诊）、对治疗的期望（50%）以及预先护理计划（14%）。对于82%的患者，就最佳治疗决策提出了建议：39%的患者建议采用更强化的治疗，42%的患者建议采用强度较低的治疗，19%的患者仅建议给予支持性护理。结果表明，老年会诊有助于做出复杂的治疗决策，可能减少老年癌症患者的过度治疗和治疗不足情况。
