Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan.
Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan.
Age Ageing. 2022 Jul 1;51(7). doi: 10.1093/ageing/afac145.
to assess the efficacy of comprehensive geriatric assessment (CGA) for preventing treatment-related toxicity in older people undergoing non-surgical cancer therapies.
MEDLINE, EMBASE and Cochrane library databases were searched from inception till January 2022 to identify randomised controlled trials (RCTs) on the incidence of toxicity measured by the Common Terminology Criteria for Adverse Events (primary outcome) and that of therapeutic modifications, early treatment discontinuation, progression-free survival, overall survival and hospitalisation (secondary outcomes).
analysis of six RCTs published from 2016 to 2021 recruiting 2,126 participants (median age: 71-77) who received chemotherapy as the major therapeutic approach revealed 51.7% and 64.7% of Grade 3+ toxicity in the CGA and control (i.e. standard care) groups, respectively (RR = 0.81, 95% CI: 0.7-0.94, P = 0.005, I2 = 65%, certainty of evidence [COE]: moderate). There were no significant differences in the incidence of early treatment discontinuation (RR = 0.88, P = 0.47; I2 = 63%,1,408 participants, COE: low), initial reduction in treatment intensity (RR = 0.99, P = 0.94; I2 = 83%, 2055 participants, COE: low), treatment delay (RR = 1.06, P = 0.77, I2 = 0%, 309 participants, COE: moderate), hospitalisation (RR = 0.86, P = 0.39, I2 = 41%, 914 participants, COE: moderate), progression-free and overall survival with or without CGA. However, there was an association between CGA and a lower incidence of dose reduction during treatment (RR = 0.73, P < 0.00001, 956 participants, COE: moderate).
our results demonstrated that comprehensive geriatric assessment may be associated with a lower incidence of treatment-related toxicity and dose reduction compared to standard care in older people receiving non-surgical cancer treatments. Further large-scale studies are warranted to support our findings.
评估综合老年评估（CGA）在预防非手术癌症治疗中老年患者治疗相关毒性的疗效。
从建库至 2022 年 1 月，检索 MEDLINE、EMBASE 和 Cochrane 图书馆数据库，以确定通过常见不良事件术语标准（主要结局）和治疗修改、早期治疗中断、无进展生存期、总生存期和住院率（次要结局）衡量的毒性发生率的随机对照试验（RCT）。
对 2016 年至 2021 年发表的 6 项 RCT 进行分析，共纳入 2126 名接受化疗作为主要治疗方法的参与者（中位年龄：71-77 岁），结果显示 CGA 组和对照组（即标准护理）的 3+级毒性发生率分别为 51.7%和 64.7%（RR=0.81，95%CI：0.7-0.94，P=0.005，I2=65%，证据确定性[COE]：中度）。早期治疗中断的发生率无显著差异（RR=0.88，P=0.47；I2=63%，1408 名参与者，COE：低），初始治疗强度降低（RR=0.99，P=0.94；I2=83%，2055 名参与者，COE：低），治疗延迟（RR=1.06，P=0.77，I2=0%，309 名参与者，COE：中度），住院率（RR=0.86，P=0.39，I2=41%，914 名参与者，COE：中度），以及有或无 CGA 的无进展生存期和总生存期。然而，CGA 与治疗期间剂量减少的发生率降低之间存在关联（RR=0.73，P<0.00001，956 名参与者，COE：中度）。
我们的研究结果表明，与标准护理相比，综合老年评估可能与非手术癌症治疗中老年患者治疗相关毒性和剂量减少的发生率较低相关。需要进一步的大规模研究来支持我们的发现。
