Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil.
Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA.
Cancer. 2023 Jul 1;129(13):2095-2102. doi: 10.1002/cncr.34759. Epub 2023 Mar 25.
This study sought to determine the feasibility and acceptability of a remote geriatric assessment (GA) and implementation (GAIN) program in Brazil. The authors also explored the effect of this program on health-related quality of life (HR-QOL) outcomes 3 months after initiating treatment.
This is a longitudinal study enrolling older adults (65+ years), diagnosed with any type of solid tumor, scheduled to initiate chemotherapy in a networked Brazilian cancer center. The GA was performed through telehealth. We assessed the feasibility of the remote GA, acceptability to patients, and changes in patient-centered outcomes (HR-QOL, mood, function) from baseline to month 3. Linear mixed model analysis was done, adjusting for age, gender, race, income, and disease stage.
Fifty-six patients completed all intended assessments. Notably, the threshold of feasibility was 70% and there was 92% complete adherence. Average age was 76 years old (SD = 7.2). Most patients were female (57%), married (59%), and had a college degree (46%). The most common diagnoses were gastrointestinal (39%) and gynecological cancers (18%); most were diagnosed at an advance disease stage (77%). A total of 32 patients were referred to a remote appointment and 86% followed this recommendation(s). Significant improvement in Functional Assessment of Cancer Therapy - General FACT-G (mean difference, 6.04; p < .001), Geriatric Depression Scale (mean difference, -0.86; p = .008), and instrumental activities of daily living ratio (mean difference, 0.17; p < .001) were found.
Remote GAIN is feasible and acceptable to older adults with cancer receiving treatment in Brazil. The authors also found significant improvement in HR-QOL outcomes over time. Notably, this GAIN program could guide early detection of chemotherapy toxicity and improving patient-reported outcomes in low-resource environments.
本研究旨在确定巴西远程老年评估（GA）和实施（GAIN）计划的可行性和可接受性。作者还探讨了该计划在开始治疗后 3 个月对健康相关生活质量（HR-QOL）结果的影响。
这是一项纵向研究，纳入了年龄在 65 岁以上、被诊断患有任何类型实体瘤、计划在联网的巴西癌症中心接受化疗的老年人。GA 通过远程医疗进行。我们评估了远程 GA 的可行性、患者的可接受性以及从基线到第 3 个月患者为中心的结局（HR-QOL、情绪、功能）的变化。采用线性混合模型分析，调整年龄、性别、种族、收入和疾病阶段。
56 名患者完成了所有预期评估。值得注意的是，可行性的门槛为 70%，完全依从率为 92%。平均年龄为 76 岁（标准差=7.2）。大多数患者为女性（57%）、已婚（59%）且拥有大学学历（46%）。最常见的诊断是胃肠道（39%）和妇科癌症（18%）；大多数患者处于晚期疾病阶段（77%）。共有 32 名患者被转介到远程预约，86%的患者接受了这一建议。功能性评估癌症治疗-一般 FACT-G（平均差异，6.04；p<0.001）、老年抑郁量表（平均差异，-0.86；p=0.008）和日常生活活动工具性能力比率（平均差异，0.17；p<0.001）显著改善。
远程 GAIN 对在巴西接受治疗的老年癌症患者是可行且可接受的。作者还发现 HR-QOL 结果随时间显著改善。值得注意的是，该 GAIN 计划可以指导早期发现化疗毒性，并在资源有限的环境中改善患者报告的结局。
