University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
Nat Rev Clin Oncol. 2020 Dec;17(12):742-755. doi: 10.1038/s41571-020-0421-z. Epub 2020 Sep 2.
Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.
尽管在过去的二十年中，癌症患者的治疗结果有了显著改善，但癌症老年患者（年龄≥65 岁）的人数仍在迅速增加，其治疗结果仍比年轻患者差。由于存在可能影响治疗决策和治疗结果的并存健康问题和与年龄相关的问题，因此管理老年癌症患者颇具挑战性。老年综合评估和老年筛查工具可以帮助确定癌症治疗后预后较差的高危患者，并为这些患者更好地分配治疗方案。使用基于证据的管理策略来优化老年状况可以改善医生、患者和护理人员之间的沟通和满意度，并改善该人群的临床结果。目前正在进行临床试验，以进一步确定老年综合评估与管理干预相结合对癌症结果的影响，以及在接受免疫疗法和靶向疗法等现代系统治疗时老年综合评估的预测价值。在本篇综述中，我们总结了治疗老年癌症患者的独特挑战，并描述了目前的指南和正在进行的研究，以改善这些患者的治疗结果。
