Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland.
Data Science Centre, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland.
Curr Oncol. 2022 Aug 26;29(9):6167-6176. doi: 10.3390/curroncol29090484.
The Comprehensive Geriatric Assessment (CGA) is recommended to guide treatment choices in older patients with cancer. Patients ≥ 70 years referred to our oncology service with a new cancer diagnosis are screened using the G-8. Patients with a score of ≤14 are eligible to attend the Geriatric Oncology and Liaison (GOAL) Clinic in our institution, with referral based on physician discretion. Referred patients undergo multidimensional assessments at baseline. CGA domains assessed include mobility, nutritional, cognitive, and psychological status. Chemotherapy toxicity risk is estimated using the Cancer Aging and Research Group (CARG) calculator. We undertook a retrospective analysis of patients attending the GOAL clinic over a 30-month period to April 2021. The objective was to determine rates of treatment dose modifications, delays, discontinuation, and unscheduled hospitalizations as surrogates for cytotoxic therapy toxicity in these patients. These data were collected retrospectively. Ninety-four patients received chemotherapy; the median age was 76 (70-87) and 45 were female (48%). Seventy-five (80%) had an ECOG PS of 0-1. Seventy-two (77%) had gastrointestinal cancer, and most had stage III (47%) or IV (40%) disease. Chemotherapy with curative intent was received by 51% ( = 48) and 51% received monotherapy. From the CGA, the median Timed Up and Go was 11 s (7.79-31.6), and 90% reported no falls in the prior 6 months. The median BMI was 26.93 (15.43-39.25), with 70% at risk or frankly malnourished by the Mini Nutritional Assessment. Twenty-seven (29%) patients had impaired cognitive function. Forty-three (46%) had a high risk of toxicity based on the baseline CARG toxicity calculator. Twenty-six (28%) required dose reduction, 55% ( = 52) required a dose delay, and 36% ( = 34) had a hospitalization due to toxicity. Thirty-nine patients (42%) discontinued treatment due to toxicity. Despite intensive assessment, clinical optimization and personalized treatment decisions, older adults with cancer remain at high risk of chemotherapy toxicity.
综合老年评估（CGA）被推荐用于指导老年癌症患者的治疗选择。我们的肿瘤科对年龄≥70 岁、新诊断癌症的患者进行 G-8 筛查。评分≤14 的患者有资格参加我们机构的老年肿瘤学和联络（GOAL）诊所，转诊由医生决定。被转诊的患者在基线时进行多维评估。评估的 CGA 领域包括移动能力、营养、认知和心理状态。使用癌症老化和研究组（CARG）计算器估计化疗毒性风险。我们对 2018 年 4 月至 2021 年 30 个月期间参加 GOAL 诊所的患者进行了回顾性分析。目的是确定这些患者的治疗剂量调整、延迟、停药和非计划性住院率，作为细胞毒性治疗毒性的替代指标。这些数据是回顾性收集的。94 名患者接受了化疗；中位年龄为 76（70-87）岁，45 名女性（48%）。75 名（80%）患者的 ECOG PS 评分为 0-1。72 名（77%）患有胃肠道癌症，大多数患者处于 III 期（47%）或 IV 期（40%）。51%（=48）的患者接受了治愈性化疗，51%的患者接受了单一药物治疗。根据 CGA，计时起立行走测试的中位数为 11 秒（7.79-31.6），90%的患者报告在过去 6 个月内没有跌倒。中位 BMI 为 26.93（15.43-39.25），70%的患者存在营养风险或明显营养不良。27 名（29%）患者认知功能受损。43 名（46%）患者根据基线 CARG 毒性计算器存在高毒性风险。26 名（28%）需要减少剂量，55%（=52）需要延迟剂量，36%（=34）因毒性而住院。39 名患者（42%）因毒性而停止治疗。尽管进行了强化评估、临床优化和个性化治疗决策，老年癌症患者仍面临高化疗毒性风险。
Eur Urol Focus. 2018-1-10
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