Department of Medicine and Medical Oncology, Royal Columbian Hospital, New Westminster, BC.
University of British Columbia, Vancouver, BC.
Curr Oncol. 2019 Aug;26(4):234-239. doi: 10.3747/co.26.4869. Epub 2019 Aug 1.
Expert groups have recommended incorporation of a geriatric assessment into clinical practice for older patients starting oncologic therapy. However, that practice is not standard primarily because of resource limitations. In the present study, we evaluated the effect on treatment decisions by oncologists in the community oncology setting of a brief geriatric assessment tool that estimates risk of toxicity.
This prospective longitudinal study in 5 community oncology practices in British Columbia involved patients 70 years of age and older starting a new cytotoxic chemotherapy regimen. Clinical personnel completed a brief validated geriatric assessment tool-the Cancer and Aging Research Group chemotherapy toxicity tool (carg-tt)-that estimates the risk of grade 3 or greater toxicity in older patients. Physicians were asked if the carg-tt changed their treatment plan or prompted extra supports. Patients were followed to assess the incidence of toxicity during treatment.
The study enrolled 199 patients between July 2016 and February 2018. Mean age was 77 years. Treatment was palliative in 61.4% of the group. Compared with physician judgment, the carg-tt predicted higher rates of toxicity. In 5 patients, treatment was changed based on the carg-tt. In 38.5% of the patients, data from the tool prompted extra supports. Within the first 3 cycles of treatment, 21.3% of patients had experienced grade 3 or greater toxicity.
This study demonstrates that use of a brief geriatric assessment tool is possible in a broad community oncology practice. The tool modified the oncologist's supportive care plan for a significant number of older patients undertaking cytotoxic chemotherapy.
专家组建议将老年评估纳入开始肿瘤治疗的老年患者的临床实践中。然而，由于资源限制，这种做法并未成为标准。在本研究中，我们评估了在社区肿瘤学环境中使用一种简短的老年评估工具来评估毒性风险对肿瘤学家治疗决策的影响。
这项在不列颠哥伦比亚省 5 家社区肿瘤学实践中的前瞻性纵向研究涉及 70 岁及以上开始新细胞毒性化疗方案的患者。临床人员完成了一个简短的经过验证的老年评估工具——癌症和老龄化研究组化疗毒性工具（carg-tt），该工具估计老年患者发生 3 级或更高级别毒性的风险。医生被问及 carg-tt 是否改变了他们的治疗计划或需要额外的支持。对患者进行随访以评估治疗期间的毒性发生率。
该研究于 2016 年 7 月至 2018 年 2 月期间纳入了 199 名患者。平均年龄为 77 岁。该组中 61.4%的患者接受姑息治疗。与医生的判断相比，carg-tt 预测了更高的毒性发生率。在 5 名患者中，根据 carg-tt 改变了治疗方案。在 38.5%的患者中，工具数据提示需要额外的支持。在治疗的前 3 个周期内，21.3%的患者出现了 3 级或更高级别的毒性。
本研究表明，在广泛的社区肿瘤学实践中使用简短的老年评估工具是可行的。该工具改变了相当数量接受细胞毒性化疗的老年患者的肿瘤学家支持性护理计划。
