Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States.
Division of Medical Oncology, Duke University, Durham, NC, United States.
J Geriatr Oncol. 2019 Jan;10(1):164-168. doi: 10.1016/j.jgo.2018.06.004. Epub 2018 Jun 27.
Geriatric screening tools assess functional limitations and inform clinical decision-making for older adults with cancer. Our objective was to evaluate the feasibility and effectiveness of a screener in community-based oncology clinics.
Eligible patients were from two rural, underserved community-based cancer clinics; within 12 months of a cancer diagnosis (breast, lung, colorectal, pancreas, esophageal); aged ≥60 years; and not exclusively pursuing palliative care. We used a previously validated tool that was embedded in the electronic health record (EHR). Patient-reported responses identified memory impairment, depressive symptoms, deficits in activities of daily living, poor nutrition, and polypharmacy. At the discretion of the oncologist, responses prompted service referrals. From the EHR, we extracted information about referrals and completion of planned therapy. We present descriptive statistics.
Enrolled patients (n = 44) had a mean age of 71.5 years (SD = 6.9). Most were non-white (61%), women (66%), with government-sponsored health insurance (80%). The most commonly identified geriatric syndromes: polypharmacy (89%), reduced quality of life (39%), and poor nutrition (39%). The screener triggered a referral in 98% of patients. Generated referrals were for depressive symptoms (52% needed, 39% received), nutrition (43% needed, 37% received), and polypharmacy (89% needed, 26% received). Patients were referred to social work (56%), nutrition (44%), and pharmacy (25%). Many patients completed planned radiation therapy (100%), surgery (70%), and chemotherapy (60%).
Use of an EHR-embedded brief geriatric oncology assessment in rural oncology clinics identified geriatric syndromes that would benefit from provision of services in nearly all enrolled patients.
ClinicalTrials.gov Identifier: NCT02906592.
老年综合评估工具可评估功能障碍，并为癌症老年患者的临床决策提供信息。我们的目的是评估社区肿瘤诊所中筛查工具的可行性和有效性。
符合条件的患者来自两家农村、服务不足的社区肿瘤诊所；癌症诊断后 12 个月内（乳腺癌、肺癌、结直肠癌、胰腺癌、食管癌）；年龄≥60 岁；并非专门接受姑息治疗。我们使用了一种先前经过验证的工具，该工具已嵌入电子健康记录（EHR）中。患者报告的反应识别出记忆障碍、抑郁症状、日常生活活动能力下降、营养状况不佳和多重用药。根据肿瘤医生的判断，反应提示服务转介。从 EHR 中，我们提取了有关转介和计划治疗完成情况的信息。我们提供描述性统计信息。
入组患者（n=44）的平均年龄为 71.5 岁（SD=6.9）。大多数是非白人（61%），女性（66%），有政府赞助的医疗保险（80%）。最常见的老年综合征：多重用药（89%）、生活质量下降（39%）和营养状况不佳（39%）。筛查工具在 98%的患者中触发了转介。生成的转介是针对抑郁症状（52%需要，39%接受）、营养（43%需要，37%接受）和多重用药（89%需要，26%接受）。患者被转介到社会工作（56%）、营养（44%）和药房（25%）。许多患者完成了计划的放疗（100%）、手术（70%）和化疗（60%）。
在农村肿瘤诊所使用 EHR 嵌入式简要老年肿瘤评估识别出了近所有入组患者都需要服务的老年综合征。
ClinicalTrials.gov 标识符：NCT02906592。
