Geriatric Oncology Service, National Hospital Organization (NHO) Kyushu Cancer Center, Japan.
Department of Gastrointestinal and Medical Oncology, NHO Kyushu Cancer Center, Japan.
Intern Med. 2021 Sep 15;60(18):2927-2932. doi: 10.2169/internalmedicine.6760-20. Epub 2021 Mar 29.
Objective Geriatric screening followed by a more detailed assessment and intervention is recommended for older adults with cancer. However, little is known regarding how the geriatric screening covered by Japanese health insurance is used for hospitalized older cancer patients. We surveyed all hospitals in Japanese Association of Clinical Cancer Centers (JACCC) to explore the current use of this approach. Methods The JACCC member hospitals specialize in cancer care from prevention, through diagnosis and treatment, to palliative care. We mailed paper questionnaires to the presidents of the hospitals in December 2019 and collected them by February 2020. The survey requested general hospital information and asked whether (and how) such geriatric screening for hospitalized older adults with cancer was conducted. Results Twenty-six of 32 hospitals completed the survey (81%). Fourteen hospitals are cancer centers, while the remaining 12 hospitals are general hospitals which care of both cancer and non-cancer patients. Eleven hospitals (42%) performed geriatric screening and the most common use of the results was for "early discharge planning" and for "applying for long-term care insurance." Most clinicians rated the screening "somewhat" or "a little" helpful and found it most helpful for "meeting patient-post discharge needs". The most frequently reported barrier to implementation was a "lack of leadership to improve the care of older adults." Conclusion Geriatric screening was used at less than half of the major cancer centers and hospitals in Japan. One feasible solution to this problem is to establish an interprofessional workgroup at each hospital with the shared goal of providing high-quality care for this population.
建议对患有癌症的老年患者进行老年综合评估和干预,但目前对于日本医疗保险涵盖的老年综合评估在住院老年癌症患者中的应用情况知之甚少。我们对日本临床肿瘤学会(JACCC)的所有医院进行了调查,以探讨这种方法的应用现状。
JACCC 成员医院专门从事癌症治疗,涵盖预防、诊断和治疗以及姑息治疗。我们于 2019 年 12 月向医院院长邮寄纸质问卷,并于 2020 年 2 月前收集。调查要求提供医院的一般信息,并询问是否(以及如何)对住院老年癌症患者进行这种老年综合评估。
32 家医院中有 26 家(81%)完成了调查。14 家医院为癌症中心,其余 12 家医院为综合医院,同时治疗癌症和非癌症患者。11 家医院(42%)进行了老年综合评估,结果最常用于“提前出院计划”和“申请长期护理保险”。大多数临床医生对评估的评价为“有些”或“有点”有帮助,并发现其对“满足患者出院后需求”最有帮助。实施的最常见障碍是“缺乏改善老年人护理的领导力”。
日本的主要癌症中心和医院中,不到一半的医院使用老年综合评估。解决这个问题的一个可行方法是在每家医院建立一个跨专业工作组,共同目标是为这一人群提供高质量的护理。