General Surgery Resident, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA.
Assistant Professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
CA Cancer J Clin. 2017 Sep;67(5):362-377. doi: 10.3322/caac.21406. Epub 2017 Jul 21.
Answer questions and earn CME/CNE The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes. In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors. In addition, over 70 different measures of frailty have been proposed. Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. CA Cancer J Clin 2017;67:362-377. © 2017 American Cancer Society.
回答问题并赚取 CME/CNE 衰弱的概念已越来越被认为是医疗保健和健康结果中最重要的问题之一，对于接受手术、化疗和放疗治疗的癌症患者尤其重要。由于癌症本身以及提供的治疗方法都可能是严重的额外压力源，挑战患者的生理储备，因此老年癌症患者中衰弱的发生率特别高-据估计，超过一半的老年癌症患者衰弱或衰弱前期。然而，定义衰弱可能具有挑战性。简单地说，衰弱是一种对压力源极度脆弱的状态，导致不良的健康结果。实际上，衰弱是一种复杂的、多维的、周期性的生理储备减少状态，导致弹性和适应能力下降，对压力源的脆弱性增加。此外，已经提出了 70 多种不同的衰弱衡量标准。尽管如此，已经证明衰弱患者术后并发症、化疗不耐受、疾病进展和死亡的风险增加。尽管需要对衰弱的切点进行国际标准化，但肿瘤学医生和外科医生继续努力识别衰弱并促进多学科决策，将有助于制定更个体化的管理策略，并优化癌症患者的护理。CA 癌症 J Clin 2017;67:362-377。©2017 美国癌症协会。
