Williams Grant R, Kenzik Kelly M, Parman Mariel, Al-Obaidi Mustafa, Francisco Liton, Rocque Gabrielle B, McDonald Andrew, Paluri Ravi, Navari Rudolph M, Nandagopal Lakshmin, Gbolahan Olumide, Young-Smith Crystal, Robertson Matthew, Bhatia Smita
Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, United Kingdom; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, United Kingdom.
Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, United Kingdom; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, United Kingdom.
J Geriatr Oncol. 2020 Mar;11(2):270-273. doi: 10.1016/j.jgo.2019.04.008. Epub 2019 Apr 18.
Integrating Geriatric Assessment (GA) in the management of older adults with cancer is recommended, yet rarely practiced in routine oncologic care. Our objective was to assess the feasibility of integrating routine GA in the management of older adults with gastrointestinal (GI) malignancies and characterize impairments in this population.
Patients ≥60yo referred for consultation to the GI Oncology clinic were asked to complete the Cancer and Aging Resilience Evaluation (CARE) on their first visit. CARE was adapted from the Cancer and Aging Research Group GA with modifications to create a completely patient-reported version of the GA. Feasibility was defined as completion of CARE by ≥80% of eligible patients during the initial consultation.
Of the eligible 354 new patients seen in the GI Oncology Clinic, 323 (91.2%) completed the CARE survey. Most patients (83.1%) felt the length of time to complete was appropriate (median time of 10 min [IQR 10-15.7 min]). GA impairments were prevalent: 54.7% reported dependence in Instrumental Activities of Daily Living, 15.5% reported dependence in Activities of Daily Living, 20.9% reported ≥1 fall, 35.9% reported a performance status ≥2, 55.7% were limited in walking one block, 74.0% reported polypharmacy (≥4 medications), and 36.4% had ≥3 comorbidities.
Performing a GA in the routine care of older adults with GI malignancies is feasible, and GA impairments are common among this population. A fully patient-reported GA such as the CARE may facilitate broader incorporation of GA in the routine clinic work flow.
建议将老年评估（GA）纳入老年癌症患者的管理中，但在常规肿瘤护理中很少实施。我们的目的是评估将常规GA纳入老年胃肠道（GI）恶性肿瘤患者管理中的可行性，并描述该人群的功能障碍情况。
被转诊至GI肿瘤门诊咨询的60岁及以上患者在首次就诊时被要求完成癌症与衰老恢复力评估（CARE）。CARE是根据癌症与衰老研究组的GA改编而来，并进行了修改以创建一个完全由患者报告的GA版本。可行性定义为在初次咨询期间≥80%的符合条件患者完成CARE。
在GI肿瘤门诊就诊的354名符合条件的新患者中，323名（91.2%）完成了CARE调查。大多数患者（83.1%）认为完成调查的时间合适（中位时间为10分钟[四分位间距10 - 15.7分钟]）。GA功能障碍很普遍：54.7%的患者报告在工具性日常生活活动方面存在依赖，15.5%的患者报告在日常生活活动方面存在依赖，20.9%的患者报告有≥1次跌倒，35.9%的患者报告体能状态≥2，55.7%的患者行走一个街区受限，74.0%的患者报告使用多种药物（≥4种药物），36.4%的患者有≥3种合并症。
在老年GI恶性肿瘤患者的常规护理中进行GA是可行的，且GA功能障碍在该人群中很常见。像CARE这样完全由患者报告的GA可能有助于在常规门诊工作流程中更广泛地纳入GA。
