老年综合评估在癌症老年患者临床实践中的应用如何？美国临床肿瘤学会对癌症提供者的调查。
How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology.
机构信息
City of Hope National Medical Center, Duarte, CA.
University of Alabama at Birmingham, Birmingham, AL.
出版信息
JCO Oncol Pract. 2021 Jun;17(6):336-344. doi: 10.1200/OP.20.00442. Epub 2020 Oct 15.
PURPOSE
For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers' practices using GA. Therefore, ASCO's Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA.
METHODS
Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO's Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at < .05.
RESULTS
Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% 50%; < .001) and falls (62% 45%; < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%).
CONCLUSION
Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.
目的
对于年龄大于 65 岁的癌症患者，2018 年 ASCO 指南建议进行老年综合评估（GA）。然而，关于提供者使用 GA 的实践的数据有限。因此，ASCO 老年肿瘤学工作组对提供者进行了一项调查，以评估 GA 的实践模式和障碍。
方法
治疗包括≥65 岁的成年患者的癌症提供者完成了在线调查。问题包括对 ASCO 老年肿瘤学指南（2018 年）的认识、使用经过验证的 GA 工具以及对使用 GA 的感知障碍。对了解指南和不了解指南的提供者进行了描述性统计和统计比较。统计显著性设定为 <.05。
结果
参与者（N=1277）于 2019 年 4 月 5 日至 6 月 5 日之间做出回应。约有一半（53%）表示了解该指南。在了解该指南的人和不了解该指南的人当中，使用最多的 GA 工具是评估功能状态（69% 50%；<.001）和评估跌倒（62% 45%；<.001）。其余工具的使用频率均<50%，包括评估体重减轻、合并症、认知、预期寿命、化疗毒性、情绪和非癌症死亡率风险的工具。了解该指南的人的 GA 使用频率是不知道该指南的人的两倍至四倍。对于那些报告说知道该指南的人来说，最常见的障碍是缺乏资源，特别是时间（81.7%）和人员（77.0%）。相比之下，那些不知道该指南的人最常报告的障碍是：缺乏知识或培训（78.4%）、缺乏对工具的认识（75.2%）以及对工具使用的不确定性（75.0%）。
结论
在照顾老年人的提供者中，52%的人知道 ASCO 指南。一些领域经常被评估（例如，功能、跌倒），而其他领域很少被评估（例如，情绪、认知）。对该指南的了解与 GA 使用增加两到四倍以及不同的感知障碍有关。促进指南一致性实施的干预措施将需要各种策略来改变行为。
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