Applied Radiation Therapy Trinity (ARTT) research group, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland.
Department of Radiation Oncology, St George Hospital, Sydney, NSW 2217, Australia.
Clin Oncol (R Coll Radiol). 2020 Nov;32(11):766-774. doi: 10.1016/j.clon.2020.06.011. Epub 2020 Jul 6.
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood.
在治疗老年癌症患者时，需要考虑许多额外因素，尤其是在姑息治疗的背景下。目前，在某些国家和疾病部位，放射治疗的应用不足，但在其他情况下也存在过度治疗的证据。为老年患者做出合理的治疗决策需要对患者的生理储备能力进行基本评估。这被称为“虚弱”，其临床表现存在很大的异质性，从相对健壮、适合标准治疗的患者，到身体虚弱、可能需要不同治疗方法的患者。虚弱评估也为干预提供了一个重要机会，对于需要综合老年评估（CGA）的患者，可以在评估后进行干预。一般来说，在老年肿瘤学指南中，提倡采用两步法，首先进行简短的初步筛选，然后进行 CGA。这有可能优化老年患者的护理，并且可能逆转或减缓虚弱的发展。因此，它对患者的生活质量有重要影响，在姑息治疗的背景下尤其受到重视。虚弱评估还可以更深入地讨论治疗结果和采用共同决策方法。至于放疗方案本身，有许多适应性的改变可以更好地为老年人提供便利，从定位和固定，到治疗方案。治疗疗程应尽可能缩短，并考虑到老年人的独特情况。还应考虑患者、护理人员或家庭/支持网络前往治疗的额外负担。减少治疗次数至单次分割可能是合适的，或者采用分次治疗方案。为了加强护理并满足快速老龄化人口的需求，未来的放射肿瘤学专业人员需要接受老年医学基本原理的教育，因为许多方面仍未得到充分理解。
