Okoli George N, Stirling Morgan, Racovitan Florentin, Lam Otto Lt, Reddy Viraj K, Copstein Leslie, Hsu Tina, Abou-Setta Ahmed M, Dawe David E
George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
CancerCare Manitoba, Winnipeg, Manitoba, Canada.
Curr Probl Cancer. 2021 Jun;45(3):100699. doi: 10.1016/j.currproblcancer.2020.100699. Epub 2021 Jan 12.
Sixty percent of newly diagnosed cancers occur in older adults and more complex planning is required to sustain quality care for older populations. Individualized care incorporating geriatric assessment can predict early mortality and treatment toxicity for older cancer patients. We mapped and summarized the available evidence on the integration of geriatric assessment into clinical oncology practice, and ascertained which domains have been implemented. We systematically searched bibliographic databases and trial registries for reports of clinical studies, clinical practice guidelines, systematic and non-systematic reviews, and grey literature published in English. We gathered data on study characteristics, geriatric domains and strategies evaluated, and relevant study objectives and findings. From a total of 10,124 identified citations, 38 articles met our eligibility criteria, 3 of which were clinical practice guidelines. Nearly half of these articles came from the United States. Domains of the geriatric assessment implemented in studies ranged from 1 to 12, with varied combinations. We identified 27 studies on strategies for implementing geriatric assessment and 24 studies on feasibility of implementing geriatric assessment, into clinical oncology practice. We also identified 3 main geriatric assessment models: 2 from the United States and 1 from Australia. Furthermore, we identified 2 reviews that reported varied components of geriatric assessment models. There is increasingly robust evidence to implement formal geriatric assessment in oncology practice. There remains a great deal of variation in the tools recommended to address each of the domains in a geriatric assessment, with only 1 guideline (American Society of Clinical Oncology guideline) settling on a specific best practice. Protocol registration: Open Science Framework osf.io/mec93.
60%新确诊的癌症发生在老年人中,需要更复杂的规划以维持对老年人群的优质护理。纳入老年评估的个体化护理能够预测老年癌症患者的早期死亡率和治疗毒性。我们梳理并总结了将老年评估整合到临床肿瘤学实践中的现有证据,并确定了哪些领域已得到实施。我们系统检索了文献数据库和试验注册库,以查找英文发表的临床研究报告、临床实践指南、系统评价和非系统评价以及灰色文献。我们收集了关于研究特征、评估的老年领域和策略以及相关研究目标和结果的数据。在总共识别出的10124条引文中,38篇文章符合我们的纳入标准,其中3篇为临床实践指南。这些文章中近一半来自美国。研究中实施的老年评估领域从1个到12个不等,组合各异。我们识别出27项关于实施老年评估策略的研究以及24项关于将老年评估纳入临床肿瘤学实践可行性的研究。我们还识别出3种主要的老年评估模型:2种来自美国,1种来自澳大利亚。此外,我们识别出2篇综述,报告了老年评估模型的不同组成部分。在肿瘤学实践中实施正式的老年评估有越来越充分的证据。在推荐用于解决老年评估中每个领域问题的工具方面,仍然存在很大差异,只有1项指南(美国临床肿瘤学会指南)确定了具体的最佳实践。方案注册:开放科学框架osf.io/mec93