Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Eur J Surg Oncol. 2021 Mar;47(3 Pt A):597-602. doi: 10.1016/j.ejso.2020.11.002. Epub 2020 Dec 3.
Liver, biliary tract and pancreatic cancers are increasingly diseases of older people and the global population is aging. 'Older/senior' patients are a heterogeneous group who vary widely in their general health, physical reserve and degree of dependence on others. Cancer is not the only disease that becomes more prevalent in old age, which means older/senior patients may also have comorbidities and lower resilience. The use of chemotherapy decreases as age increases. Chemotherapy treatment regimens may require modification to reduce toxicity, which is more common in older/senior patients. The effect this has on treatment efficacy is not fully understood. Older/senior patients are not represented well in clinical trials which makes estimating benefit for these patients challenging. Medicine demands that new drugs are rigorously tested and evaluated before use, yet clinicians are treating older/senior patients on the basis of extrapolating from randomised controlled trials which actively exclude comorbidities and older patients. This review considers the current situation and the value of retrospective analyses and real-world evidence to plug the older/senior patient 'data gaps'. Moving forwards it is essential to broaden clinical trial inclusion criteria to include more older/senior people. The use of appropriate geriatric assessments may help selection of older patients who are fit enough for more rigorous treatment regimens, alongside effective methods of predicting and managing treatment toxicities. The ability to see past the numerical age of a person and offer appropriate therapeutic choices to individual patients in clinic, is an important skill for younger (and not so young) Medical Oncologists to learn.
肝癌、胆管癌和胰腺癌患者日益呈现老龄化趋势，且全球人口也在不断老龄化。“老年”患者是一个异质性群体，他们在整体健康状况、身体储备和对他人的依赖程度方面差异很大。癌症并不是老年人中唯一更为常见的疾病，这意味着老年患者可能还患有合并症且身体恢复能力更差。随着年龄的增长，化疗的应用会减少。化疗治疗方案可能需要修改以降低毒性，而老年患者更容易出现这种情况。这对治疗效果的影响尚未完全了解。临床试验中很少有老年患者参与，这使得评估这些患者的获益具有挑战性。医学要求新药在使用前进行严格的测试和评估，但临床医生根据排除了合并症和老年患者的随机对照试验来对老年患者进行治疗。这篇综述讨论了目前的情况，以及回顾性分析和真实世界证据在填补老年患者“数据空白”方面的价值。向前发展，扩大临床试验纳入标准以纳入更多老年患者至关重要。适当的老年评估的使用可以帮助选择适合更严格治疗方案的老年患者，同时还需要有效的方法来预测和管理治疗毒性。在临床中，超越患者的年龄数字并为每个患者提供合适的治疗选择，是年轻（和不太年轻）肿瘤医生需要掌握的一项重要技能。
