Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
Division of Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
Semin Oncol. 2019 Aug-Oct;46(4-5):341-345. doi: 10.1053/j.seminoncol.2019.09.001. Epub 2019 Oct 1.
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
老年血液病患者的管理较为复杂，且鉴于最近及预期的人口统计学趋势，这种情况日益常见。美国退伍军人事务部作为一个庞大的、全国性的医疗一体化系统，有可能引领相关研究，使这些患者受益。在这篇综述中，我们描述了血液病治疗模式的演变，以及如何通过全面评估关键脆弱性，使这些治疗方法最适合老年患者。我们还讨论了如何优化支持性护理和导航服务，以针对确定的风险和挑战进行优化，从而减轻患者的癌症和治疗负担。最后，我们讨论了在设计前瞻性临床试验方面的机会，以更好地与实际病例相匹配，从而扩大血液病老年患者的入组和适用性。
