Gans Emma A, Portielje Johanneke E A, Dekkers Olaf M, de Kroon Cor D, van Munster Barbara C, Derks Marloes G M, Trompet Stella, van Holstein Yara, Mooijaart Simon P, van Poelgeest Mariette I E, van den Bos Frederiek
University Medical Center Groningen, University Center of Geriatric Medicine, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Leiden University Medical Center, Department of Gerontology and Geriatrics, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Leiden University Medical Center, Department of Medical oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
J Geriatr Oncol. 2023 Mar;14(2):101442. doi: 10.1016/j.jgo.2023.101442. Epub 2023 Feb 3.
Vulvar cancer is a disease that mainly affects older women. Frailty is an important predictor of outcomes and geriatric assessment can help tailor treatment decisions and improve outcomes. This study aims to assess the prevalence of frailty in older women with vulvar cancer, and how it relates to integrated geriatric care and treatment according to the oncological guidelines.
A single-center cohort study was performed, among patients 70 years and older, who were diagnosed with vulvar cancer at Leiden University Medical Center, between January 2012 and May 2020. Data on geriatric assessment, treatment decision-making and treatment-related outcomes were collected.
Our study included 114 patients. Mean age was 79.7 years, and 52 patients (45.6%) were frail. Of the frail patients, 42.0% were referred to a geriatrician. In eight of these cases, the geriatrician was actively involved in weighing the benefit and harm of standard oncological treatment versus de-escalated treatment. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with referral to a geriatrician and with active involvement of a geriatrician in decision making. In 26 of frail patients (50.0%) oncological treatment was de-escalated. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with de-escalation of treatment. De-escalated treatment did not compromise survival.
Frailty is prevalent among older women with vulvar cancer and is associated with referral to a geriatrician and de-escalation of oncological treatment. While this reflects that it is deemed important to tailor treatment decision for frail patients, most frail patients are not routinely evaluated by a geriatrician. Further multidisciplinary collaboration and research is necessary to optimize tailored treatment decisions for this patient group.
外阴癌是一种主要影响老年女性的疾病。虚弱是预后的重要预测指标，老年评估有助于制定个性化的治疗决策并改善预后。本研究旨在评估老年外阴癌女性患者的虚弱患病率，以及其与综合老年护理和根据肿瘤学指南进行的治疗之间的关系。
在2012年1月至2020年5月期间，于莱顿大学医学中心对70岁及以上被诊断为外阴癌的患者进行了一项单中心队列研究。收集了老年评估、治疗决策和治疗相关结局的数据。
我们的研究纳入了114例患者。平均年龄为79.7岁，52例患者（45.6%）虚弱。在虚弱患者中，42.0%被转诊至老年病科医生处。在其中8例病例中，老年病科医生积极参与权衡标准肿瘤治疗与降阶梯治疗的利弊。虚弱、高龄、躯体功能障碍、认知障碍和功能依赖与转诊至老年病科医生以及老年病科医生积极参与决策相关。在虚弱患者中有26例（50.0%）进行了肿瘤治疗的降阶梯。虚弱、高龄、躯体功能障碍、认知障碍和功能依赖与治疗降阶梯相关。降阶梯治疗并未影响生存率。
虚弱在外阴癌老年女性患者中普遍存在，且与转诊至老年病科医生和肿瘤治疗降阶梯相关。虽然这反映出为虚弱患者制定个性化治疗决策被认为很重要，但大多数虚弱患者并未接受老年病科医生进行常规评估。需要进一步开展多学科协作和研究，以优化针对该患者群体的个性化治疗决策。
