City of Hope National Medical Center, Duarte, CA.
Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.
J Clin Oncol. 2023 Sep 10;41(26):4293-4312. doi: 10.1200/JCO.23.00933. Epub 2023 Jul 17.
To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy.
An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022.
A total of 26 publications met eligibility criteria and form the evidentiary basis for the update.
The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate.The Panel recommends the Practical Geriatric Assessment as one option for this purpose (https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf; https://youtu.be/jnaQIjOz2Dw; https://youtu.be/nZXtwaGh0Z0).Additional information is available at www.asco.org/supportive-care-guidelines.
更新 ASCO 指南（2018 年），以评估和管理老年癌症患者系统治疗中与年龄相关的脆弱性。
专家小组进行了系统评价，以确定 2016 年 1 月至 2022 年 12 月期间的相关随机临床试验（RCT）、系统评价和荟萃分析。
共有 26 篇文献符合入选标准，为本次更新提供了证据基础。
专家组重申其之前指南中的总体建议，即应使用老年综合评估（GA），包括所有必要的领域，来识别 65 岁以上癌症患者的常规肿瘤评估中未发现的脆弱性或损伤。基于最近发表的 RCT 表明，GA 指导的管理（GAM）可显著改善临床结局，因此所有接受 GA 识别缺陷的系统治疗的老年癌症患者（65 岁以上）都应在其护理计划中包含 GAM。GAM 包括使用 GA 结果来告知癌症治疗决策，以及通过适当的干预、咨询和/或转介来解决损伤。GA 应包括与老年癌症患者结局相关的高优先级与衰老相关的领域：身体和认知功能、情绪健康、合并症、多种药物治疗、营养和社会支持。基于患者人群、资源和时间，对 GA 进行临床调整是合适的。专家组建议将实用老年评估作为一种选择（https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf; https://youtu.be/jnaQIjOz2Dw; https://youtu.be/nZXtwaGh0Z0）。更多信息可在 www.asco.org/supportive-care-guidelines 上获取。
