Ursem Carling, Diaz-Ramirez L Grisell, Boscardin John, Lee Sei
Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco VA Medical Center, United States of America.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, United States of America.
J Geriatr Oncol. 2021 Jun;12(5):808-812. doi: 10.1016/j.jgo.2020.12.011. Epub 2020 Dec 30.
Although older men value maintaining independence and avoiding functional decline, little is known about their functional trajectories with receipt of prostate radiation.
We performed a retrospective cohort study including veterans age 65+ with localized prostate cancer who resided in a VA nursing facility while receiving prostate radiation from 2005 to 2015. We evaluated the change in Minimum Data Set (MDS) activities of daily living (ADL) score during 6 months from the start of treatment. Because prior studies have shown Charlson Comorbidity Index (CCI) to be a strong predictor of treatment-related toxicity, analysis included interaction with CCI.
We identified 487 patients with median age 73 (range 65-94). For the average patient in our cohort, the predicted MDS-ADL score worsened from 2.9 (95% CI 2.4-3.6) at the start of radiation to 3.8 (95% CI 3.1-4.8) at 3 months and then 4.5 (95% CI 3.5-5.7) at month 6. Patients with greater comorbidity (CCI ≥ 4) had worse functional outcomes in months 0-3 compared to patients with less comorbidity (CCI 0-3). MDS-ADL score worsened by 1.9 in the CCI ≥4 patients compared to 0.3 in the CCI 0-3 group During months 3-6, patients in both Charlson groups experienced similar worsening of MDS-ADL score.
In a vulnerable population of older patients with localized prostate cancer, radiation was associated with a decline in functional independence. Patients with higher comorbidity experienced more severe functional decline within the first 3 months of radiation therapy. In all comorbidity levels, functional status had not returned to baseline by 6 months.
尽管老年男性重视保持独立并避免功能衰退，但对于接受前列腺放疗后的功能轨迹了解甚少。
我们进行了一项回顾性队列研究，纳入了2005年至2015年期间居住在退伍军人事务部（VA）护理机构且接受前列腺放疗的65岁及以上的局限性前列腺癌退伍军人。我们评估了从治疗开始6个月内最低数据集（MDS）日常生活活动（ADL）评分的变化。由于先前的研究表明Charlson合并症指数（CCI）是治疗相关毒性的有力预测指标，因此分析包括与CCI的相互作用。
我们确定了487例患者，中位年龄为73岁（范围65 - 94岁）。对于我们队列中的普通患者，预测的MDS-ADL评分从放疗开始时的2.9（95%置信区间2.4 - 3.6）恶化至3个月时的3.8（95%置信区间3.1 - 4.8），然后在6个月时为4.5（95%置信区间3.5 - 5.7）。与合并症较少（CCI 0 - 3）的患者相比，合并症较重（CCI≥4）的患者在0 - 3个月时功能结局更差。CCI≥4的患者MDS-ADL评分恶化了1.9，而CCI 0 - 3组为0.3。在3 - 6个月期间，两个Charlson组的患者MDS-ADL评分均出现类似程度的恶化。
在老年局限性前列腺癌这一脆弱人群中，放疗与功能独立性下降有关。合并症较高的患者在放疗的前3个月内功能衰退更严重。在所有合并症水平中，6个月时功能状态均未恢复至基线。
