Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts.
University of Maryland School of Medicine, Baltimore, Maryland.
J Natl Compr Canc Netw. 2020 Mar;18(3):305-313. doi: 10.6004/jnccn.2019.7355.
Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes.
This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival.
Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08-5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14-4.48; P=.020).
Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.
肿瘤学家在处理老年人癌症特有的复杂问题时常常感到力不从心，因此需要研究来确定预后不良风险较高的患者。
本研究纳入了在诊断为不可治愈的胃肠道癌症后 8 周内年龄≥70 岁的患者。使用患者报告的调查评估脆弱性（脆弱老年人调查[得分≥3 表示脆弱性筛查阳性]）、生活质量（癌症患者 EORTC 生活质量问卷[得分越高表示生活质量越好]）和症状（埃德蒙顿症状评估系统[ESAS；得分越高表示症状负担越重]和老年抑郁量表[得分越高表示抑郁症状越严重]）。评估了入组后 90 天内的非计划住院和总生存情况。我们使用回归模型来检查脆弱性、生活质量、症状负担、住院和总生存之间的关联。
在 132 名被接触的患者中，有 102 名（77.3%）入组（平均[M]±SD 年龄，77.25±5.75 岁）。近一半（45.1%）筛查为脆弱性阳性，这些患者年龄更大（M，79.45 岁 vs 75.44 岁；P=.001），合并症更多（M，2.13 与 1.34；P=.017）与非脆弱性患者相比。脆弱性患者在所有领域的生活质量评分都较差（总体生活质量：M，53.26 与 66.82；P=.041；身体生活质量：M，58.95 与 88.24；P<.001；角色生活质量：M，53.99 与 82.12；P=.001；情绪生活质量：M，73.19 与 85.76；P=.007；认知生活质量：M，79.35 与 92.73；P=.011；社会生活质量：M，59.42 与 82.42；P<.001），症状负担更高（ESAS 总分：M，31.05 与 15.00；P<.001），抑郁评分更差（M，4.74 与 2.25；P<.001）。脆弱性患者无计划住院的风险更高（危险比，2.38；95%CI，1.08-5.27；P=.032），总生存情况更差（危险比，2.26；95%CI，1.14-4.48；P=.020）。
筛查为脆弱性阳性的老年癌症患者经历更高的症状负担、更多的医疗保健使用和更差的生存。应将脆弱性识别工具纳入实践，以指导临床护理。
