Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia.
School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia.
Int J Environ Res Public Health. 2023 Nov 23;20(23):7105. doi: 10.3390/ijerph20237105.
Advances in cardiovascular therapies and cancer treatments have resulted in longer patient survival. The coexistence of cancer and cardiovascular disease has been recognized as a complex clinical scenario. In addition to cardiovascular disease, older people with cancer are at greater risk of experiencing multimorbidity and geriatric syndromes, such as frailty. In older people, the concurrent presence of cancer and cardiovascular disease increases the risk of mortality, and the presence of frailty can exacerbate their conditions and hinder treatment effectiveness. Given the significant intersection among frailty, cardiovascular disease, and cancer in older people, this paper aims to provide an overview of the current research in this field and identifies gaps in the research to understand the burden and impact of frailty in these populations. While many studies have examined the prevalence and impact of frailty on adverse outcomes in patients with cancer or cardiovascular disease, evidence of frailty in individuals with both conditions is lacking. There is no universally accepted definition of frailty, which leads to inconsistencies in identifying and measuring frailty in older adults with cardiovascular disease and cancer. The frailty index seems to be a preferred frailty definition in studies of patients with cancer, while the frailty phenotype seems to be more commonly used in cardiovascular research. However, differences in how the frailty index was categorized and in how patients were classified as 'frail' depending on the cut points may have a negative effect on understanding the impact of frailty in the studied populations. This makes it challenging to compare findings across different studies and limits our understanding of the prevalence and impact of frailty in these populations. Addressing these research gaps will contribute to our understanding of the burden of frailty in older people with cardiovascular disease and cancer, and improve clinical care protocols in this vulnerable population.
心血管治疗和癌症治疗的进步导致患者的生存时间延长。癌症和心血管疾病共存已被认为是一种复杂的临床情况。除了心血管疾病外，患有癌症的老年人还面临着多种疾病和老年综合征（如虚弱）的更高风险。在老年人中，癌症和心血管疾病的同时存在会增加死亡率的风险，而虚弱的存在会使他们的病情恶化，并影响治疗效果。鉴于虚弱、心血管疾病和癌症在老年人中存在显著的交叉，本文旨在提供该领域当前研究的概述，并确定研究中的差距，以了解这些人群中虚弱的负担和影响。虽然许多研究已经检查了虚弱在癌症或心血管疾病患者不良结局中的患病率和影响，但在同时患有这两种疾病的个体中，虚弱的证据仍然缺乏。目前还没有普遍接受的虚弱定义，这导致在患有心血管疾病和癌症的老年人中识别和测量虚弱时存在不一致性。虚弱指数似乎是癌症患者研究中首选的虚弱定义，而虚弱表型在心血管研究中更为常见。然而，由于分类虚弱指数的方式以及根据切点将患者分类为“虚弱”的方式存在差异，这可能会对理解虚弱在研究人群中的影响产生负面影响。这使得跨不同研究比较结果变得具有挑战性，并限制了我们对这些人群中虚弱的患病率和影响的理解。解决这些研究差距将有助于我们了解患有心血管疾病和癌症的老年人中虚弱的负担，并改善该脆弱人群的临床护理方案。
