Farcet Anaïs, de Decker Laure, Pauly Vanessa, Rousseau Frédérique, Bergman Howard, Molines Catherine, Retornaz Frédérique
Unité de coordination en oncologie gériatrique, Centre Gérontologique Départemental, Marseille, France.
Département de Gériatrie, Centre Hospitalo-Universitaire, Nantes, France.
PLoS One. 2016 Feb 26;11(2):e0149732. doi: 10.1371/journal.pone.0149732. eCollection 2016.
Comprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. Some authors have suggested that the concept of frailty could be a more useful approach in this population. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic.
This prospective study included 70 years and older patients with solid tumors and referred for an oncogeriatric assessment. The CGA included nine domains: autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls, and social status. Five frailty markers were assessed (nutrition, physical activity, energy, mobility, and strength). Patients were categorized as Frail (three or more frailty markers), pre-frail (one or two frailty markers), or not-frail (no frailty marker). Treatment recommendations were classified into two categories: standard treatment with and without any changes and supportive/palliative care. Multiple logistic regression models were used to analyze factors associated with treatment recommendations.
217 patients, mean age 83 years (± Standard deviation (SD) 5.3), were included. In the univariate analysis, number of frailty markers, grip strength, physical activity, mobility, nutrition, energy, autonomy, depression, Eastern Cooperative Oncology Group Scale of Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations. In the multivariate analysis, the number of frailty markers and basic Activities of Daily Living (ADL) were significantly associated with final treatment recommendations (p<0.001 and p = 0.010, respectively).
Frailty markers are associated with final treatment recommendations in older cancer patients. Longitudinal studies are warranted to better determine their use in a geriatric oncology setting.
综合老年评估（CGA）是帮助肿瘤学家为老年患者选择最佳癌症治疗方案的金标准。一些作者认为，衰弱概念可能是针对这一人群更有用的方法。我们调查了在老年肿瘤门诊中，衰弱标志物是否与治疗建议相关。
这项前瞻性研究纳入了70岁及以上的实体瘤患者，并转介进行老年肿瘤评估。CGA包括九个领域：自主性、合并症、用药、认知、营养、情绪、神经感觉缺陷、跌倒和社会地位。评估了五个衰弱标志物（营养、身体活动、能量、活动能力和力量）。患者被分类为衰弱（三个或更多衰弱标志物）、衰弱前期（一个或两个衰弱标志物）或非衰弱（无衰弱标志物）。治疗建议分为两类：有或无任何改变的标准治疗以及支持性/姑息性护理。使用多元逻辑回归模型分析与治疗建议相关的因素。
纳入了217名患者，平均年龄83岁（±标准差（SD）5.3）。在单变量分析中，衰弱标志物数量、握力、身体活动、活动能力、营养、能量、自主性、抑郁、东部肿瘤协作组体能状态量表（ECOG-PS）和跌倒与最终治疗建议显著相关。在多变量分析中，衰弱标志物数量和日常生活基本活动能力（ADL）与最终治疗建议显著相关（分别为p<0.001和p = 0.010）。
衰弱标志物与老年癌症患者的最终治疗建议相关。有必要进行纵向研究，以更好地确定它们在老年肿瘤学环境中的用途。
