Monfardini Silvio, Morlino Sara, Valdagni Riccardo, Catanzaro Mario, Tafa Ardit, Bortolato Barbara, Petralia Giovanni, Bonetto Elisa, Villa Elisa, Picozzi Stefano, Locatelli Maria Cristina, Galetti Giuseppe, Millul Andrea, Albanese Yasmin, Bianchi Elisa, Panzarino Claudia, Gerardi Francesca, Beghi Ettore
Istituto Palazzolo Fondazione Don Gnocchi, Milano, Italy.
Radioterapia, Istituto Nazionale Tumori Milano, Italy.
J Geriatr Oncol. 2017 Jul;8(4):289-295. doi: 10.1016/j.jgo.2017.02.011. Epub 2017 Mar 11.
To investigate a comprehensive geriatric assessment (CGA) with subsequent investigation of healthcare patterns in older patients with urological cancers undergoing initial surgery or radiotherapy, to verify the usefulness of the incorporation of geriatric principles in future care plans.
This is a prospective cohort study. From November 2011 to March 2015, CGA was offered to all patients aged 70+ years treated with radiotherapy or surgery at seven tertiary centers. Patients were classified as fit, vulnerable, or frail according to Balducci's definition. CGA and follow-up data were collected by two trained evaluators at 6 and 12months. The information collected was not available to the caring physicians during follow-up.
CGA was performed in 453 patients with prostate cancer (295), bladder cancer (126), or kidney cancer (32). 40% of patients with prostate cancer were fit, 47% vulnerable, and 13% frail. The corresponding values for renal cancer were 25%, 40%, and 34%, and for bladder cancer, 21%, 42%, and 37%. During follow-up, 60% of patients with cardiac diseases, 42% of those with diabetes/other metabolic disorders, 35% of those with hypertension, and 35% of those with respiratory diseases were followed by a specialist (for these severe/extremely severe comorbidities). Of 16 patients with ADL impairment and 63 with IADL impairment, only 4 (25%) and 6 (10%), respectively, were referred to a rehabilitation service. Only one case was referred to a geriatrician.
Appropriate clinical care patterns are advisable to improve quality of survivorship in older patients with urological cancers.
对接受初次手术或放疗的老年泌尿系统癌症患者进行综合老年评估（CGA），并随后调查其医疗模式，以验证在未来护理计划中纳入老年医学原则的实用性。
这是一项前瞻性队列研究。2011年11月至2015年3月，在7个三级中心对所有接受放疗或手术治疗的70岁及以上患者进行CGA。根据巴尔杜奇的定义，将患者分为健康、脆弱或虚弱三类。由两名经过培训的评估人员在6个月和12个月时收集CGA和随访数据。随访期间，护理医生无法获取所收集的信息。
对453例前列腺癌（295例）、膀胱癌（126例）或肾癌（32例）患者进行了CGA。40%的前列腺癌患者健康，47%脆弱，13%虚弱。肾癌的相应比例分别为25%、40%和34%，膀胱癌为21%、42%和37%。在随访期间，60%的心脏病患者、42%的糖尿病/其他代谢紊乱患者、35%的高血压患者和35%的呼吸系统疾病患者由专科医生随访（针对这些严重/极其严重的合并症）。在16例日常生活活动（ADL）受损患者和63例工具性日常生活活动（IADL）受损患者中，分别只有4例（25%）和6例（10%）被转介至康复服务机构。仅1例患者被转介至老年病科医生处。
建议采用适当的临床护理模式，以提高老年泌尿系统癌症患者的生存质量。
