Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands.
Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark.
J Geriatr Oncol. 2022 Jul;13(6):761-777. doi: 10.1016/j.jgo.2022.04.008. Epub 2022 May 8.
The aim of this systematic review is to summarize all available data on the effect of a geriatric assessment in older patients with cancer, for oncologic treatment decisions, the implementation of non-oncologic interventions, patient-doctor communication, and treatment outcome. Additionally, we examined the impact of the type of assessment used.
Systematic Medline and Embase search for studies on the effect of a geriatric assessment on oncologic treatment decisions, non-oncologic interventions, communication, and outcome.
Sixty-five publications from 61 studies were included. After a geriatric assessment, the oncologic treatment plan was altered in a median of 31% of patients (range 7-56%), with highest change rates in studies using a multidisciplinary team evaluation. Non-oncologic interventions were recommended in over 70% of patients, provided that an intervention plan or specific expertise was in place. A geriatric assessment led to more goals-of-care discussions and improved communication. The geriatric assessment also led to lower toxicity/complication rates (most strongly if the assessment outcomes were considered during decision making), improved likelihood of treatment completion, and improved physical functioning and quality of life in the majority of included studies.
A geriatric assessment can change oncologic treatment plans, leads to non-oncologic interventions, and improve communication about care planning and ageing-related issues. It can decrease toxicity/complications and improve treatment completion and patient-centred outcomes. If multidisciplinary or geriatric input is not available, having a pre-defined non-oncologic intervention plan is important. To maximize the effect on outcomes, the result of the geriatric assessment should be incorporated into oncologic decision-making.
本系统评价旨在总结所有关于老年癌症患者进行老年评估对肿瘤治疗决策、非肿瘤干预措施的实施、医患沟通和治疗结果的影响的数据。此外，我们还研究了所使用评估类型的影响。
系统检索 Medline 和 Embase 中关于老年评估对肿瘤治疗决策、非肿瘤干预措施、沟通和结果影响的研究。
61 项研究中有 65 篇文献被纳入。在进行老年评估后，中位比例（范围 7-56%）的患者的肿瘤治疗计划发生改变，采用多学科团队评估的研究中改变率最高。超过 70%的患者建议进行非肿瘤干预措施，如果有干预计划或特定专业知识，则提供这些措施。老年评估可促进更多的临终关怀讨论和改善沟通。老年评估还可降低毒性/并发症发生率（如果在决策过程中考虑评估结果，则效果更强），提高治疗完成率，并改善大多数纳入研究中的身体功能和生活质量。
老年评估可以改变肿瘤治疗计划，促进非肿瘤干预措施，并改善关于护理计划和与年龄相关问题的沟通。它可以降低毒性/并发症发生率，并提高治疗完成率和以患者为中心的结局。如果没有多学科或老年医学的投入，制定明确的非肿瘤干预计划很重要。为了最大限度地提高对结局的影响，应将老年评估的结果纳入肿瘤决策中。
