老年功能障碍与接受放疗的老年癌症患者生活质量下降及身体功能减退相关——一项前瞻性观察研究。
Geriatric impairments are associated with reduced quality of life and physical function in older patients with cancer receiving radiotherapy - A prospective observational study.
作者信息
Eriksen Guro Falk, Benth Jūratė Šaltytė, Grønberg Bjørn Henning, Rostoft Siri, Kirkhus Lene, Kirkevold Øyvind, Oldervoll Line Merethe, Bye Asta, Hjelstuen Anne, Slaaen Marit
机构信息
The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway; Department of Internal Medicine, Hamar Hospital, Innlandet Hospital Trust, Postboks 4453, 2326 Hamar, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, 0318 Oslo, Norway.
The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O.Box 1171, 0318 Blindern, Norway; Health Services Research Unit, Akershus University Hospital, P.O.Box 1000, 1478 Lørenskog, Norway.
出版信息
J Geriatr Oncol. 2023 Jan;14(1):101379. doi: 10.1016/j.jgo.2022.09.008. Epub 2022 Sep 27.
INTRODUCTION
Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments.
MATERIALS AND METHODS
A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models.
RESULTS
301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes.
DISCUSSION
Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance. Registered at clinicaltrials.gov (NCT03071640).
引言
生活质量（QoL）和功能是老年癌症患者的重要预后指标。我们旨在评估在放射治疗（RT）期间，（1）有治愈或姑息治疗意图的组与（2）根据老年损伤数量定义的组之间患者报告结局（PROs）趋势的差异。
材料与方法
进行了一项前瞻性观察性研究，纳入年龄≥65岁接受治愈性或姑息性放疗的患者。放疗前进行老年评估（GA），并确定每个领域内损伤的临界值。患者根据老年损伤数量分组：0、1、2、3和≥4。我们的主要结局，即总体生活质量和身体功能（PF），在基线、放疗结束时以及放疗后两周、八周和十六周通过欧洲癌症研究与治疗组织生活质量核心问卷（EORTC）（QLQ-C30）进行评估。通过线性混合模型评估组间结局趋势的差异。
结果
共纳入301例患者，平均年龄73.6岁，53.8%接受治愈性放疗。与治愈组相比，接受姑息性放疗的患者报告的总体生活质量和身体功能明显更差。0、1、2、3和≥4种老年损伤的患病率分别为16.6%、22.7%、16.9%、16.3%和27.5%。总体生活质量和身体功能随着损伤数量的增加而逐渐下降。从基线到整个随访期间，这些组间差异保持稳定，任何结局均无任何临床显著变化。
讨论
老年损伤数量的增加对总体生活质量和身体功能有深远的负面影响，但未观察到任何组或结局有进一步下降，这表明放疗总体耐受性良好。因此，老年损伤本身不应成为拒绝放疗的理由。老年评估是识别需要支持性措施的脆弱患者的关键，这些措施可能有提高治疗耐受性的潜力。在clinicaltrials.gov注册（NCT03071640）。
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