Triozzi P L, Goldstein D, Laszlo J
Ohio State University, Columbus.
Clin Geriatr Med. 1987 Aug;3(3):505-16.
In assessing the needs of the elderly patient with cancer, we need first to determine the extent of cancer, its complications, and the type of comorbid physical and psychologic conditions. The next step is to determine the goals of our care and specifically the extent to which supportive care is needed to deal with problems. For supportive care to be truly effective, the specific underlying condition producing a complaint must be investigated. It is also important not to underestimate the significance of a symptom such as constipation. Furthermore, nutritional support requires as much planning as, for example, the control of pain. Some problems (eg, nausea, vomiting, pain, and constipation) are best managed with preventive measures; others (eg, anemia, granulocytopenia, and coagulopathies) have very specific indications for intervention. Considerable progress has been made toward understanding the mechanisms of clinical problems such as nausea and vomiting, and a more rational approach to supportive therapy is now possible. However, it is usually not possible to recommend any one intervention for a particular problem: no one intervention is uniformly effective or safe. Aggressive supportive care in elderly cancer patients can improve their ability to tolerate anti-cancer therapies and, more importantly, provide palliation of distressing symptoms.
在评估老年癌症患者的需求时，我们首先需要确定癌症的范围、其并发症以及合并存在的身体和心理状况的类型。下一步是确定我们的护理目标，特别是处理问题所需的支持性护理的程度。为了使支持性护理真正有效，必须对引发主诉的具体潜在病症进行调查。同样重要的是，不要低估诸如便秘等症状的重要性。此外，营养支持与例如疼痛控制一样需要精心规划。一些问题（如恶心、呕吐、疼痛和便秘）最好通过预防措施来处理；其他问题（如贫血、粒细胞减少和凝血障碍）有非常具体的干预指征。在理解诸如恶心和呕吐等临床问题的机制方面已经取得了相当大的进展，现在有可能采用更合理的支持性治疗方法。然而，通常不可能针对某个特定问题推荐任何一种干预措施：没有一种干预措施是普遍有效或安全的。对老年癌症患者积极进行支持性护理可以提高他们耐受抗癌治疗的能力，更重要的是，缓解痛苦症状。
