综合老年评估对接受全身抗癌治疗的老年人所接受的护理、治疗完成情况、毒性、癌症相关及老年评估结果以及生活质量的影响：一项系统综述。
The effect of comprehensive geriatric assessment on care received, treatment completion, toxicity, cancer-related and geriatric assessment outcomes, and quality of life for older adults receiving systemic anti-cancer treatment: A systematic review.
作者信息
Disalvo Domenica, Moth Erin, Soo Wee Kheng, Garcia Maja V, Blinman Prunella, Steer Christopher, Amgarth-Duff Ingrid, Power Jack, Phillips Jane, Agar Meera
机构信息
Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, Sydney NSW, Australia.
出版信息
J Geriatr Oncol. 2023 Nov;14(8):101585. doi: 10.1016/j.jgo.2023.101585. Epub 2023 Aug 10.
INTRODUCTION
This systematic review aims to summarise the available literature on the effect of geriatric assessment (multidimensional health assessment across medical, social, and functional domains; "GA") or comprehensive geriatric assessment (geriatric assessment with intervention or management recommendations; "CGA") compared to usual care for older adults with cancer on care received, treatment completion, adverse treatment effects, survival and health-related quality of life.
MATERIALS AND METHODS
A systematic search of MEDLINE, EMBASE, CINAHL, and PubMed was conducted to identify randomised controlled trials or prospective cohort comparison studies on the effect of GA/CGA on care received, treatment, and cancer outcomes for older adults with cancer.
RESULTS
Ten studies were included: seven randomised controlled trials (RCTs), two phase II randomised pilot studies, and one prospective cohort comparison study. All studies included older adults receiving systemic therapy, mostly chemotherapy, for mixed cancer types (eight studies), colorectal cancer (one study), and non-small cell lung cancer (one study). Integrating GA/CGA into oncological care increased treatment completion (three of nine studies), reduced grade 3+ chemotherapy toxicity (two of five studies), and improved quality of life scores (four of five studies). No studies found significant differences in survival between GA/CGA and usual care. GA/CGA incorporated into care decisions prompted less intensive treatment and greater non-oncological interventions, including supportive care strategies.
DISCUSSION
GA/CGA integrated into the care of an older adult with cancer has the potential to optimise care decisions, which may lead to reduced treatment toxicity, increased treatment completion, and improved health-related quality of life scores.
引言
本系统评价旨在总结现有文献，比较老年评估（跨医学、社会和功能领域的多维度健康评估；“GA”）或综合老年评估（包含干预或管理建议的老年评估；“CGA”）与常规护理相比，对老年癌症患者所接受的护理、治疗完成情况、不良治疗效果、生存率及健康相关生活质量的影响。
材料与方法
对MEDLINE、EMBASE、CINAHL和PubMed进行系统检索，以确定关于GA/CGA对老年癌症患者所接受的护理、治疗及癌症结局影响的随机对照试验或前瞻性队列比较研究。
结果
纳入了10项研究：7项随机对照试验（RCT）、2项II期随机试点研究和1项前瞻性队列比较研究。所有研究均纳入了接受全身治疗（主要为化疗）的老年患者，癌症类型包括混合癌（8项研究）、结直肠癌（1项研究）和非小细胞肺癌（1项研究）。将GA/CGA纳入肿瘤护理可提高治疗完成率（9项研究中的3项）、降低3级及以上化疗毒性（5项研究中的2项）并改善生活质量评分（5项研究中的4项）。没有研究发现GA/CGA与常规护理在生存率上有显著差异。纳入护理决策的GA/CGA促使采用强度较低的治疗和更多的非肿瘤干预措施，包括支持性护理策略。
讨论
将GA/CGA纳入老年癌症患者的护理有可能优化护理决策，这可能会降低治疗毒性、提高治疗完成率并改善健康相关生活质量评分。
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