跨学科远程医疗诊所为老年癌症患者的发展和实施-初步数据。
Development and implementation of an interdisciplinary telemedicine clinic for older patients with cancer-Preliminary data.
机构信息
Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Weil Cornell Medical College, New York, New York, USA.
出版信息
J Am Geriatr Soc. 2023 May;71(5):1638-1649. doi: 10.1111/jgs.18267. Epub 2023 Feb 6.
BACKGROUND
Frailty assessment is an important marker of the older adult's fitness for cancer treatment independent of age. Pretreatment geriatric assessment (GA) is associated with improved mortality and morbidity outcomes but must occur in a time sensitive manner to be useful for cancer treatment decision making. Unfortunately, time, resources and other constraints make GA difficult to perform in busy oncology clinics. We developed the Cancer and Aging Interdisciplinary Team (CAIT) clinic model to provide timely GA and treatment recommendations independent of patient's physical location.
METHODS
The interdisciplinary CAIT clinic model was developed utilizing the surge in telemedicine during the COVID-19 pandemic. The core team consists of the patient's oncologist, geriatrician, registered nurse, pharmacist, and registered dietitian. The clinic's format is flexible, and the various assessments can be asynchronous. Patients choose the service method-in person, remotely, or hybrid. Based on GA outcomes, the geriatrician provides recommendations and arrange interventions. An assessment summary including life expectancy estimates and chemotoxicity risk calculator scores is conveyed to and discussed with the treating oncologist. Physician and patient satisfaction were assessed.
RESULTS
Between May 2021 and June 2022, 50 patients from multiple physical locations were evaluated in the CAIT clinic. Sixty-eight percent was 80 years of age or older (range 67-99). All the evaluations were hybrid. The median days between receiving a referral and having the appointment was 8. GA detected multiple unidentified impairments. About half of the patients (52%) went on to receive chemotherapy (24% standard dose, 28% with dose modifications). The rest received radiation (20%), immune (12%) or hormonal (4%) therapies, 2% underwent surgery, 2% chose alternative medicine, 8% were placed under observation, and 6% enrolled in hospice care. Feedback was extremely positive.
CONCLUSIONS
The successful development of the CAIT clinic model provides strong support for the potential dissemination across services and institutions.
背景
虚弱评估是老年患者是否适合癌症治疗的一个重要指标，与年龄无关。治疗前老年评估（GA）与改善死亡率和发病率结果相关，但必须在及时的情况下进行，以便对癌症治疗决策有用。不幸的是，时间、资源和其他限制使得在繁忙的肿瘤诊所进行 GA 变得困难。我们开发了癌症和老龄化多学科团队（CAIT）诊所模式，以提供及时的 GA 和治疗建议，而不受患者身体位置的影响。
方法
利用 COVID-19 大流行期间远程医疗的激增，开发了跨学科的 CAIT 诊所模式。核心团队由患者的肿瘤学家、老年病学家、注册护士、药剂师和注册营养师组成。该诊所的模式灵活，各种评估可以异步进行。患者选择服务方式-亲自、远程或混合。根据 GA 的结果，老年病学家提供建议并安排干预措施。一份包括预期寿命估计和化疗毒性风险计算器评分的评估总结传达给并与治疗肿瘤学家讨论。评估了医生和患者的满意度。
结果
2021 年 5 月至 2022 年 6 月期间，50 名来自多个物理地点的患者在 CAIT 诊所接受了评估。68%的患者年龄在 80 岁或以上（年龄范围为 67-99 岁）。所有评估均为混合模式。从收到转介到预约的中位数天数为 8 天。GA 检测到多种未被识别的损伤。大约一半的患者（52%）接受了化疗（24%标准剂量，28%剂量调整）。其余的接受了放疗（20%）、免疫（12%）或激素（4%）治疗，2%接受了手术，2%选择了替代药物，8%被观察，6%进入临终关怀。反馈非常积极。
结论
CAIT 诊所模式的成功开发为在服务和机构中广泛传播提供了有力支持。
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