Breast Unit, Department of Medicine Department, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, London, UK.
Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Bedford Park, SA, Australia.
J Geriatr Oncol. 2020 Nov;11(8):1190-1198. doi: 10.1016/j.jgo.2020.07.008. Epub 2020 Jul 16.
The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.
COVID-19 大流行给老年癌症患者的平等和循证管理带来了障碍。国际老年肿瘤学会（SIOG）组织了一个专家组，就大流行对该年龄组癌症护理的几个方面的影响制定共识建议，包括老年评估（GA）、手术、放疗、系统治疗、姑息治疗和研究。年龄和癌症诊断是 COVID-19 感染不良结局的重要预测因素。在这种情况下，GA 特别有助于做出决策。GA 可能有助于估计生理储备和适应能力，评估提供或暂时停止治疗的风险-收益，以及确定患者的偏好，以帮助告知治疗决策。在资源有限的情况下，可以远程使用老年筛查工具来识别需要全面 GA 的患者。远程医疗对于确保充分的护理连续性和最大限度地降低感染暴露风险也至关重要。一般来说，治疗决策应倾向于最有效和最微创的方法，同时最大限度地降低不良后果的风险。在某些情况下，这可能需要推迟或省略手术、放疗或系统治疗，特别是在收益有限且有其他安全治疗选择的情况下。需要开展更多的研究来扩大对老年癌症患者管理的认识。然而，大流行带来了重大障碍，应努力确保公平获得临床试验和前瞻性数据收集，以阐明 COVID-19 在这一人群中的结局。
