Department of Geriatric Medicine, Fundación Jiménez Díaz University Hospital, Avenida Reyes Católicos, 2. CP 28040, Madrid, Spain.
Health Research Institute IIS-FJD, Madrid, Spain.
Eur Geriatr Med. 2023 Dec;14(6):1393-1402. doi: 10.1007/s41999-023-00870-2. Epub 2023 Oct 12.
A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment.
Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan-Meier survival curves.
Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival (p = 0.002), response to treatment (p < 0.001) and likelihood of increased frailty (p = 0.024) were observed, with type III-IV patients showing significantly worse outcomes.
Performance of standardized, systematic CGA by geriatricians permits older lymphoma patients to be classified according to frailty, with significant differences in terms of clinical outcomes across groups. We propose incorporating CGA performed by geriatricians as part of the multidisciplinary care team to optimize therapeutic strategy for these patients.
本研究分析了综合老年评估（CGA）方案在老年淋巴瘤患者中的应用，旨在进行基于虚弱的患者分类和个体化治疗。
本研究纳入了 2016 年 5 月至 2021 年 3 月期间在三级医院老年科就诊的 70 岁以上的淋巴瘤患者。评估方案包括合并症、多种药物治疗、营养、功能和精神状态、老年综合征和预期寿命。CGA 根据虚弱评估工具评分以及临床、功能和精神状态将患者分为 4 组（I 型至 IV 型）。使用参数和非参数统计检验和 Kaplan-Meier 生存曲线比较变量。
共纳入 93 例患者（55.9%为女性），中位年龄为 81.1 岁（±5.7）。23 例（24.7%）患者被归类为健壮（I 型），30 例（32.3%）为虚弱前期（II 型），具有潜在可逆转缺陷，38 例（40.9%）为虚弱（III 型），2 例（2.2%）为需要姑息治疗（IV 型）。患者接受了肿瘤特异性治疗，根据 CGA 结果对 64.5%的病例进行了治疗调整。观察到总生存期（p=0.002）、治疗反应（p<0.001）和虚弱增加的可能性（p=0.024）存在差异，III 型和 IV 型患者的结局明显较差。
由老年病学家进行标准化、系统的 CGA 可根据虚弱对老年淋巴瘤患者进行分类，各组之间的临床结局存在显著差异。我们建议将老年病学家进行的 CGA 纳入多学科护理团队，以优化这些患者的治疗策略。
