Thibaud Vincent, Billy Claire, Prud'homm Joaquim, Garin Jeanne, Hue Benoit, Cattenoz Catherine, Somme Dominique, Corvol Aline
Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France.
Department of Hematology, CHU Rennes, Université Rennes 1, 35000 Rennes, France.
Cancers (Basel). 2022 Mar 24;14(7):1642. doi: 10.3390/cancers14071642.
There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what "usual care" means will improve the external validity of such studies.
人们普遍认为，对于患有实体瘤或血液系统恶性肿瘤的老年患者，采用综合老年评估（CGA）是良好的临床实践。完整的CGA必须包括老年评估和干预计划。根据国际老年肿瘤学会（SIOG）的共识，CGA应评估多个领域：功能状态、合并症、认知、心理健康状况、疲劳、社会状态与支持、营养以及老年综合征的存在情况。在确定检测问题的最佳方法方面已取得进展，但益处大多基于预后分层和癌症治疗的调整。本综述旨在评估SIOG共识中提及的各领域癌症患者检测出问题后所提出的老年干预措施的证据水平。使用针对CGA每个领域的预定义搜索算法对PubMed数据库进行了在线搜索。符合条件的文章必须有针对CGA特定领域的明确干预措施。我们筛选了1864篇文章，但仅发现了少数关于单领域干预的试验，而且这些研究通常涉及的患者群体较小。本综述强调了关于该主题的已发表研究的稀缺性。基于CGA的干预措施的具体影响尚未得到证实。多领域干预似乎很有前景，尤其是基于整体评估的干预。然而，考虑到每个领域缺乏证据，标准化似乎很困难。在多种护理环境中需要开展新的研究，并且必须采用创新设计来平衡内部效度和外部效度。对干预措施以及“常规护理”含义的准确描述将提高此类研究的外部效度。
