在识别衰弱方面，老年医学评估优于肿瘤学家的临床判断。
Geriatric assessment is superior to oncologists' clinical judgement in identifying frailty.
作者信息
Kirkhus Lene, Šaltytė Benth Jūratė, Rostoft Siri, Grønberg Bjørn Henning, Hjermstad Marianne J, Selbæk Geir, Wyller Torgeir B, Harneshaug Magnus, Jordhøy Marit S
机构信息
The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, PO box 68, Ottestad 2313, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO box 4956 Nydalen, Oslo 0424, Norway.
出版信息
Br J Cancer. 2017 Aug 8;117(4):470-477. doi: 10.1038/bjc.2017.202. Epub 2017 Jun 29.
BACKGROUND
Frailty is a syndrome associated with increased vulnerability and an important predictor of outcomes in older cancer patients. Systematic assessments to identify frailty are seldom applied, and oncologists' ability to identify frailty is scarcely investigated.
METHODS
We compared oncologists' classification of frailty (onc-frail) based on clinical judgement with a modified geriatric assessment (mGA), and investigated associations between frailty and overall survival. Patients ⩾70 years referred for medical cancer treatment were eligible. mGA-frailty was defined as impairment in at least one of the following: daily activities, comorbidity, polypharmacy, physical function or at least one geriatric syndrome (cognitive impairment, depression, malnutrition, falls).
RESULTS
Three hundred and seven patients were enroled, 288 (94%) completed the mGA, 286 (93%) were rated by oncologists. Median age was 77 years, 56% had metastases, 85% performance status (PS) 0-1. Overall, 104/286 (36%) were onc-frail and 140/288 (49%) mGA-frail, the agreement was fair (kappa value 0.30 (95% CI 0.19; 0.41)), and 67 mGA-frail patients who frequently had localised disease, good PS and received curative treatment, were missed by the oncologists. Only mGA-frailty was independently prognostic for survival (HR 1.61, 95% CI 1.14; 2.27; P=0.007).
CONCLUSIONS
Systematic assessment of geriatric domains is needed to aid oncologists in identifying frail patients with poor survival.
背景
衰弱是一种与易感性增加相关的综合征，是老年癌症患者预后的重要预测指标。很少应用系统评估来识别衰弱，且很少研究肿瘤学家识别衰弱的能力。
方法
我们将基于临床判断的肿瘤学家对衰弱的分类（肿瘤学衰弱）与改良老年评估（mGA）进行比较，并研究衰弱与总生存期之间的关联。年龄≥70岁且因癌症接受医学治疗的患者符合条件。mGA衰弱定义为以下至少一项受损：日常活动、合并症、多种药物治疗、身体功能或至少一种老年综合征（认知障碍、抑郁、营养不良、跌倒）。
结果
共纳入307例患者，288例（94%）完成了mGA，286例（93%）由肿瘤学家进行了评估。中位年龄为77岁，56%有转移，85%的体能状态（PS）为0 - 1。总体而言，104/286例（36%）为肿瘤学衰弱，140/288例（49%）为mGA衰弱，一致性为中等（kappa值0.30（95%CI 0.19；0.41）），67例mGA衰弱患者经常患有局限性疾病、PS良好且接受了根治性治疗，但被肿瘤学家遗漏。只有mGA衰弱对生存具有独立预后价值（HR 1.61，95%CI 1.14；2.27；P = 0.007）。
结论
需要对老年领域进行系统评估，以帮助肿瘤学家识别生存预后较差的衰弱患者。
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