跨学科老年和姑息治疗干预对老年癌症患者的初步随机试验。
Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer.
机构信息
1Department of Medicine, Division of Hematology and Oncology, and.
2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
出版信息
J Natl Compr Canc Netw. 2020 May;18(5):591-598. doi: 10.6004/jnccn.2019.7386.
BACKGROUND
Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer.
METHODS
Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect.
RESULTS
From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38).
CONCLUSIONS
In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.
背景
肿瘤学家在管理老年癌症患者的特殊护理需求方面常常面临困难。本研究旨在确定提供一种针对老年癌症患者的老年医学特定问题（身体功能和合并症）和姑息治疗（症状和预后理解）的跨学科干预措施的可行性。
方法
患有不可治愈的胃肠道或肺癌的年龄≥65 岁的患者被随机分配到跨学科干预组或常规护理组。干预组的患者接受了 2 次老年病医生的就诊，老年病医生解决了患者的姑息治疗需求并进行了老年评估。如果有资格参加研究的患者中有>70%的患者入组，并且有资格参加研究的患者中有>75%的患者完成了研究就诊和调查，我们就将干预措施定义为可行。在基线和第 12 周，我们评估了患者的生活质量（QoL）、症状和沟通信心。我们计算了从基线到第 12 周的各项结果的平均变化分数，并估计了从基线到第 12 周的干预效果大小（ES；Cohen's d），0.2 表示小效应，0.5 表示中效应，0.8 表示大效应。
结果
从 2017 年 2 月至 2018 年 6 月，我们随机分配了 62 名患者（55.9%的入组率[最常见的拒绝原因是感觉病得太重]；中位年龄为 72.3 岁；癌症类型：56.5%胃肠道，43.5%肺癌）。在干预组中，82.1%的患者参加了第一次就诊，79.6%的患者参加了两次就诊。总体而言，89.7%的患者完成了所有研究调查。与常规护理相比，干预组的生活质量下降较少（-0.77 与-3.84；ES=0.21），中度/重度症状数量减少（-0.69 与+1.04；ES=0.58），沟通信心提高（+1.06 与-0.80；ES=0.38）。
结论
在这项初步试验中，入组人数超过 55%，>75%的入组患者完成了所有研究就诊和调查。针对老年患者特殊护理需求的跨学科干预措施为提高患者的生活质量、症状负担和沟通信心提供了令人鼓舞的 ES 估计。
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