Pamoukdjian Frédéric, Liuu Evelyne, Caillet Philippe, Gisselbrecht Mathilde, Herbaud Stéphane, Boudou-Rouquette Pascaline, Zelek Laurent, Paillaud Elena
AP-HP, hôpital Avicenne, service de médecine gériatrique, unité de coordination en onco-gériatrie, 125, rue de Stalingrad, 93000 Bobigny, France; Université Paris 13, Sorbonne Paris Cité, laboratoire éducations et pratiques de santé (LEPS), EA3412, 93017 Bobigny, France.
CHU de Poitiers, service de gériatrie, 2, rue de la Milétrie, 86021 Poitiers, France.
Bull Cancer. 2017 Nov;104(11):946-955. doi: 10.1016/j.bulcan.2017.10.004. Epub 2017 Nov 14.
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index. The CGA allows to detect aging-related vulnerabilities in various domains (comorbidities, polypharmacy, autonomy, nutrition, mobility, cognition, mood, social) and associated with adverse outcomes during cancer treatment (reduced overall survival, perioperative complications, toxicity-related chemotherapy). The CGA is allow to elaborate a personalized treatment plan in geriatric oncology. However, to date, no algorithms based on CGA is validated to guide therapeutic decision in geriatric oncology. The collaboration between geriatrician and oncologist remains essential to elaborate an appropriate therapeutic strategy and limit the situations of over- and under-treatment. This article presents the set of tools and scores used in geriatric oncology to guide the therapeutic decision.
正如西方国家的流行病学演变所表明的那样，癌症是一种老年疾病。确实，新诊断出的癌症中有三分之二发生在65岁以上的人群中。然而，老年癌症患者常常被排除在肿瘤学临床试验之外，并且在实际中，将癌症治疗方法外推至该人群仍然很困难。科学协会建议，对70岁及以上的患者进行全面老年评估（CGA），并使用诸如G8指数等虚弱筛查工具进行筛选。CGA能够检测出各个领域（合并症、多重用药、自主性、营养、活动能力、认知、情绪、社会因素）中与衰老相关的脆弱性，这些脆弱性与癌症治疗期间的不良后果（总生存期缩短、围手术期并发症、化疗毒性）相关。CGA有助于制定老年肿瘤学的个性化治疗方案。然而，迄今为止，尚无基于CGA的算法被验证可用于指导老年肿瘤学的治疗决策。老年医学专家和肿瘤学家之间的合作对于制定适当的治疗策略以及限制过度治疗和治疗不足的情况仍然至关重要。本文介绍了老年肿瘤学中用于指导治疗决策的一系列工具和评分。
