Gajra Ajeet, Jeune-Smith Yolaine, Fortier Stephanie, Feinberg Bruce, Phillips Eli, Balanean Alexandrina, Klepin Heidi D
Cardinal Health Specialty Solutions, Dublin, OH.
Lockwood Group, Stamford, CT.
JCO Oncol Pract. 2022 Jul;18(7):e1081-e1090. doi: 10.1200/OP.21.00743. Epub 2022 Mar 9.
The use of a standardized geriatric assessment (GA) to inform treatment decisions in older adults with cancer improves quality of life, reduces treatment-related toxicity, and is guideline-recommended. This study aimed to assess community oncologists' knowledge and utilization of GAs.
Between September 2019 and February 2020, practicing US-based oncologists were invited to attend live meetings and complete web-based surveys designed to collect information on treatment decision making and various practice-based challenges in oncology care.
Among the 349 oncologists surveyed, 74% practiced in a community setting. Sixty percent did not use a formal GA to inform treatment decisions for any of their older patients; the most common reasons for not using a GA were "Too cumbersome to incorporate into routine practice" (44%) and "Adds no value beyond the comprehensive history and physical exam" (36%). Validated GA instruments used in routine clinical practice included: Mini-Mental State Exam (54%), Comprehensive Geriatric Assessment (23%), Cancer and Aging Research Group toxicity tool (12%), and Chemotherapy Risk Assessment Scale for High-Age Patients tool (9%). Nineteen percent of oncologists were not aware of any validated GA instruments. Eastern Cooperative Oncology Group performance status and comorbidities were the most frequently used assessment factors to inform treatment decisions (88% and 73%, respectively).
Many oncologists have not incorporated GA tools because of perceptions that GAs are difficult to implement or do not add any value. Increasing education of the benefits of GA-directed therapy could help to increase GA utilization among community oncologists.
使用标准化老年评估（GA）为老年癌症患者的治疗决策提供依据可改善生活质量、降低治疗相关毒性，且是指南所推荐的。本研究旨在评估社区肿瘤学家对GA的了解和使用情况。
在2019年9月至2020年2月期间，邀请美国执业肿瘤学家参加现场会议并完成基于网络的调查，旨在收集有关治疗决策以及肿瘤护理中各种基于实践的挑战的信息。
在接受调查的349名肿瘤学家中，74%在社区环境中执业。60%的人在为任何老年患者制定治疗决策时未使用正式的GA；不使用GA的最常见原因是“纳入常规实践过于繁琐”（44%）和“除全面的病史和体格检查外没有增加价值”（36%）。在常规临床实践中使用的经过验证的GA工具包括：简易精神状态检查表（54%）、综合老年评估（23%）、癌症与衰老研究组毒性工具（12%）以及高龄患者化疗风险评估量表工具（9%）。19%的肿瘤学家不了解任何经过验证的GA工具。东部肿瘤协作组体能状态和合并症是用于指导治疗决策的最常用评估因素（分别为88%和73%）。
许多肿瘤学家尚未采用GA工具，因为他们认为GA难以实施或没有任何价值。加强对GA指导治疗益处的教育可能有助于提高社区肿瘤学家对GA的使用。
