Nishijima Tomohiro F, Shimokawa Mototsugu, Esaki Taito, Morita Masaru, Toh Yasushi, Muss Hyman B
Geriatric Oncology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
J Am Geriatr Soc. 2023 Jan;71(1):259-267. doi: 10.1111/jgs.18023. Epub 2022 Sep 16.
Current guidelines recommend a comprehensive geriatric assessment (CGA) for the management of older adults with cancer. We evaluated the effect of CGA conducted by a geriatric oncology service (GOS) on the management of older adults with cancer. We also queried patients about their perceptions of the value of this process.
This was a prospective quality assessment study of 498 consecutive older adults with cancer who were referred to the GOS from May 2020 through December 2021. Treating physicians requested a consultation and the GOS conducted a CGA and assessed patient preferences. The GOS provided recommendations on cancer treatment and geriatric interventions. Patient perspectives on the consultation were evaluated using collaboRATE and modified Patient Assessment of Care for Chronic Conditions (PACIC) subscales.
A 10-item frailty index based on a CGA (FI-CGA-10) [Oncologist, 26, e1751 (2021)] in the 498 patients showed that 19% of patients were fit, 40% pre-frail, and 41% frail. Prior to CGA the intent of the proposed cancer treatment was curative in 56% (n = 280), life-extending in 40% (n = 201), and palliative in 3.4% (n = 17). After a CGA consultation, a cancer treatment decision was changed in 45% of patients. The intent of treatment after the CGA consultation was curative in 45%, life-extending in 34%, and palliative in 21%. At least one referral to relevant disciplines was recommended for 88% of patients and was implemented in 43%. As part of the GOS consultation educational support was provided to 97% of patients. Based on the collaboRATE and PACIC tools, patients perceived the GOS consultation positively and helpful for facilitating shared decision-making and patient-centered care.
Our institutional experience demonstrated the valuable effect of the CGA consultation on oncologic decision-making and geriatric interventions in a patient-centered manner.
当前指南建议对老年癌症患者进行综合老年评估（CGA）。我们评估了老年肿瘤服务（GOS）进行的CGA对老年癌症患者管理的影响。我们还询问了患者对这一过程价值的看法。
这是一项对2020年5月至2021年12月连续转诊至GOS的498例老年癌症患者进行的前瞻性质量评估研究。主治医生要求会诊，GOS进行CGA并评估患者偏好。GOS提供了关于癌症治疗和老年干预的建议。使用协作率和修改后的慢性病护理患者评估（PACIC）子量表评估患者对会诊的看法。
基于CGA的10项衰弱指数（FI-CGA-10）[《肿瘤学家》，26，e1751（2021）]在498例患者中显示，19%的患者健康，40%的患者为衰弱前期，41%的患者衰弱。在CGA之前，拟议的癌症治疗意图为治愈性的占56%（n = 280），延长生命的占40%（n = 201），姑息性的占3.4%（n = 17）。经过CGA会诊后，45%的患者改变了癌症治疗决策。CGA会诊后的治疗意图为治愈性的占45%，延长生命的占34%，姑息性的占21%。88%的患者被建议至少转诊至相关学科，其中43%得到实施。作为GOS会诊的一部分，97%的患者获得了教育支持。基于协作率和PACIC工具，患者对GOS会诊给予了积极评价，并认为有助于促进共同决策和以患者为中心的护理。
我们机构的经验表明，CGA会诊以患者为中心的方式对肿瘤决策和老年干预具有宝贵的作用。
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