a Department of Geriatrics , Aarhus University Hospital , Aarhus , Denmark.
b Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
Acta Oncol. 2018 Nov;57(11):1458-1466. doi: 10.1080/0284186X.2018.1489144. Epub 2018 Oct 3.
The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population.
Patients aged ≥70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment.
CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA.
Patients (N = 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.
通过综合老年评估（CGA）调查老年癌症患者的健康状况，并比较基线 CGA 相关的并发症，评估老年癌症患者人群对老年医学干预的需求。
年龄≥70 岁的肺癌（LC）、头颈部癌症（HNC）、结直肠癌（CRC）或上胃肠道癌（UGIC）患者被转至肿瘤内科进行癌症治疗。
在癌症治疗前进行 CGA，评估以下领域：日常生活活动（ADL）、工具性日常生活活动（IADL）、合并症、多药治疗、营养、认知和抑郁。并发症定义为因 3-4 级毒性而减少剂量和停止治疗、住院、转为姑息治疗或 90 天内死亡，从病历中确定。根据 CGA 将患者分为健康、脆弱和虚弱。
共纳入 217 名中位年龄为 75 岁（范围：70-93 岁）的患者：13%健康，35%脆弱，52%虚弱。与健康患者相比，CGA 显著预测虚弱和脆弱患者住院：风险比（RR）2.12（95%可信区间：1.01；4.46）。脆弱和虚弱患者 90 天内死亡的绝对风险高于健康患者：7%和 23%比 0%。与脆弱患者相比，90 天内死亡的风险 HR 为 3.50（95%可信区间：1.34；9.15）。需要老年医学干预的虚弱患者（88%）多于脆弱患者（46%）和健康患者（32%）。主要结论：很少有老年癌症患者看起来健康。CGA 预测混合癌症疾病老年患者的住院情况。与健康患者相比，脆弱和脆弱患者在 90 天内死亡的风险更高。
