University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
J Geriatr Oncol. 2021 Jun;12(5):779-785. doi: 10.1016/j.jgo.2020.12.003. Epub 2020 Dec 17.
Decision-making in older patients with cancer can be complex, as benefits of treatment should be weighed against possible side-effects and life-expectancy. A novel care pathway was set up incorporating geriatric assessment into treatment decision-making for older cancer patients. Treatment decisions could be modified following discussion in an onco-geriatric multidisciplinary team (MDT). We assessed the effect of treatment modifications on outcomes.
This retrospective study was performed in the surgical department of a University Hospital. Patients of 70 years and older with a solid malignancy were included. All patients underwent a nurse-led geriatric assessment (GA) and were discussed in an onco-geriatric MDT. This could result in a modified or an unchanged treatment advice compared to the regular tumor board. Primary outcome was one-year mortality. Secondary outcomes were post-operative complications and days spent in hospital in the first year after inclusion.
For the 184 patients in the analyses, the median age was 77.5 years and 41.8% were female. For 46 patients (25%), the treatment advice was modified by the onco-geriatric MDT. There was no significant difference in one-year mortality between the unchanged and modified group (29.7% versus 26.1%, p = 0.7). There were, however, significantly fewer days spent in hospital (median 5 vs 8.5 days p = 0.02) and fewer grade II or higher postoperative complications (13.3% versus 35.5% p = 0.005) in the modified group.
Incorporating geriatric assessment in decision-making did not lead to excess one-year mortality, but did result in fewer complications and days spent in hospital.
老年癌症患者的决策可能较为复杂，因为在评估治疗获益时，需要权衡潜在的副作用和预期寿命。本研究建立了一种新的护理途径，即将老年综合评估纳入老年癌症患者的治疗决策中。在肿瘤多学科团队（MDT）的讨论后，可以对治疗决策进行修改。我们评估了治疗方案修改对结局的影响。
这是一项在大学附属医院外科部门进行的回顾性研究。纳入年龄≥70 岁且患有实体恶性肿瘤的患者。所有患者均接受了护士主导的老年综合评估（GA），并在肿瘤老年 MDT 中进行了讨论。与常规肿瘤委员会相比，这可能导致治疗建议发生改变或不变。主要结局为 1 年死亡率。次要结局为纳入后第 1 年的术后并发症和住院天数。
在分析的 184 例患者中，中位年龄为 77.5 岁，41.8%为女性。46 例（25%）患者的治疗建议被肿瘤老年 MDT 改变。未改变和改变组的 1 年死亡率无显著差异（29.7%比 26.1%，p=0.7）。然而，改变组的住院天数（中位数 5 天比 8.5 天，p=0.02）和 II 级及以上术后并发症（13.3%比 35.5%，p=0.005）更少。
将老年综合评估纳入决策并未导致 1 年死亡率增加，但确实减少了并发症和住院天数。
