Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.
University Medical Centre Utrecht, Utrecht, The Netherlands.
Eur J Cancer Care (Engl). 2019 Jul;28(4):e13049. doi: 10.1111/ecc.13049. Epub 2019 Apr 29.
Treatment decision-making in older patients with cancer is difficult due to a paucity of data evaluating chemotherapy tolerability in this population. We investigated the feasibility of chemotherapy in the oldest old and performed a singl-centre retrospective analysis of patients aged ≥80 years initiating chemotherapy for one of five common solid malignancies or non-Hodgkin lymphoma between 2010 and 2016. Treatment plan and course were extracted from medical files. Primary outcome was whether chemotherapy was completed according to plan, defined as a calculated relative dose intensity (RDI) ≥85%. A total of 104 patients receiving 129 chemotherapy lines were included. Median age at diagnosis was 82 years (range 80-94 years). Most patients (64%) received palliative intent chemotherapy. Primary and secondary chemotherapy adaptations were implemented in 63% and 65% of the cases, and hospitalisation occurred in a quarter. 52% of all cases completed chemotherapy according to plan. Almost half of the chemotherapy regimens started in the oldest old were not completed according to plan, despite frequently implemented upfront adaptations. The decision to start chemotherapy in these patients should be carefully considered. To improve decision-making in current practice, there is a need for the implementation of validated tools assessing chemotherapy feasibility in these patients.
由于缺乏评估该人群化疗耐受性的数据，老年癌症患者的治疗决策颇具难度。我们研究了最年长人群接受化疗的可行性，并对 2010 年至 2016 年间，5 种常见实体瘤或非霍奇金淋巴瘤之一接受化疗的年龄≥80 岁的患者进行了单中心回顾性分析。从病历中提取治疗方案和过程。主要结局是根据计划完成化疗的情况，定义为计算得出的相对剂量强度（RDI）≥85%。共纳入 104 例接受 129 条化疗线的患者。诊断时的中位年龄为 82 岁（范围 80-94 岁）。大多数患者（64%）接受姑息性化疗。63%和 65%的患者实施了原发性和继发性化疗调整，四分之一的患者需要住院治疗。根据计划，52%的患者完成了化疗。尽管经常进行前期调整，但在最年长的人群中开始的一半以上的化疗方案仍未按计划完成。在这些患者中开始化疗的决定应慎重考虑。为了改善当前实践中的决策，需要实施经验证的工具来评估这些患者的化疗可行性。
