三种肿瘤老年综合评估工具（G8、优化 G8 和 CARG）在预测老年癌症患者化疗相关毒性中的性能。一项前瞻性临床研究。
The performance of three oncogeriatric screening tools - G8, optimised G8 and CARG - in predicting chemotherapy-related toxicity in older patients with cancer. A prospective clinical study.
机构信息
University Cancer Center Leipzig (UCCL), University Hospital Leipzig, Leipzig, Germany.
Haematology and Oncology Department, St. Georg Hospital Leipzig, Leipzig, Germany.
出版信息
J Geriatr Oncol. 2019 Nov;10(6):937-943. doi: 10.1016/j.jgo.2019.04.004. Epub 2019 May 10.
BACKGROUND
Older patients are vulnerable to chemotherapy-related toxicity (CRT). Therefore we evaluated screening tools in their power to predict CRT.
METHODS
Patients with cancer aged ≥65 years completed three screening questionnaires (G8, optimised G8 and Cancer and Ageing Research Group (CARG). Additionally, Comprehensive geriatric assessment (CGA) for verification of supportive care needs was undertaken on patients with impaired G8 scores. During chemotherapy treatment patients were assessed, capturing grade 0-5 CRT as defined by NCI CTCAE 4.
RESULTS
104 patients with non-haematological cancers were included at three study sites. Median age was 73 years (range 65-85). Onco-geriatric screening detected 74% as impaired using G8 and optimised G8 questionnaires and 86% using CARG screening. Grade 3-5 toxicity affected 64.4% of all patients. G8 (OR 0.3 95% CI [0.1;1.0]) and optimised G8 (OR 0.4 95% CI [0.1; 1.5]) did not reliably predict CRT, whereas screening with CARG demonstrated a strong prediction of severe CRT: OR 4.2, 95% CI [1.1, 15.9]. CGA was undertaken on 66 patients, revealing deficiencies in nutritional (83%) and functional-status (54%) and occurrence of relevant comorbidity (53%).
CONCLUSION
The CARG tool could be useful for predicting CRT. CGA showed clinically relevant supportive care needs in patients with a positive G8 screening.
背景
老年患者易发生化疗相关毒性（CRT）。因此，我们评估了这些筛查工具预测 CRT 的能力。
方法
≥65 岁的癌症患者完成了三个筛查问卷（G8、优化 G8 和癌症与老龄化研究小组（CARG）。此外，对 G8 评分受损的患者进行了全面的老年评估（CGA），以验证支持性护理需求。在化疗治疗期间，评估患者，根据 NCI CTCAE 4 定义捕获 0-5 级 CRT。
结果
在三个研究地点共纳入了 104 名非血液系统癌症患者。中位年龄为 73 岁（范围 65-85 岁）。使用 G8 和优化 G8 问卷，74%的患者存在认知障碍，使用 CARG 筛查则有 86%的患者存在认知障碍。所有患者中有 64.4%发生了 3-5 级毒性。G8（OR 0.3，95%CI [0.1;1.0]）和优化 G8（OR 0.4，95%CI [0.1;1.5]）均不能可靠地预测 CRT，而使用 CARG 筛查则能很好地预测严重的 CRT：OR 4.2，95%CI [1.1, 15.9]。对 66 名患者进行了 CGA，发现存在营养（83%）和功能状态（54%）缺陷以及相关合并症（53%）。
结论
CARG 工具可用于预测 CRT。在 G8 筛查阳性的患者中，CGA 显示出了临床上相关的支持性护理需求。
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