Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Department of Oncology and Hematology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland.
J Geriatr Oncol. 2024 Apr;15(3):101684. doi: 10.1016/j.jgo.2023.101684. Epub 2023 Dec 9.
Therapeutic options in oncology keep on expanding. Nonetheless, older adults are underrepresented in clinical trials and those enrolled often have a better health status than their average peers, resulting in a lack of representative evidence for this heterogenous population. The inclusion of older patients and a uniform categorization of "frailty" is becoming increasingly urgent. Standardized tools could contribute to the quality and comparability of clinical trials and facilitate clinical decisions. The aim of this literature review was to elaborate an overview of the use of geriatric evaluation (GE) methods in clinical cancer research.
We performed a literature review of the PubMed database. Clinical pharmacotherapy studies that applied or evaluated a clearly defined system for the GE of oncological patients were included. Data retrieved encompassed the applied GE method(s), cancer type(s), and pharmacotherapy investigated, the number of included patients, study type, year of publication, as well as the primary purpose of the GE. The GEs used most frequently were depicted in more depth.
In this literature review, 103 publications were selected for inclusion. The biggest proportion of studies (36%, n = 34) used clearly defined, but not previously validated, GE methods (study-specific GE). Standardized GE methods encountered in at least five publications were the G8 screening test (applied in 18% of included studies, n = 17), the Balducci score (7%, n = 7), and a geriatric assessment based on Hurria (5%, n = 5). The primary purpose of GE was predominantly an appraisal of its potential role in pharmacotherapy optimization. The GE also served as baseline and outcome measure, inclusion/exclusion criterion, factor for stratified randomization, and to determine treatment allocation.
The wide range of GE methods used across studies make direct comparisons difficult, and many methods are poorly characterized and/or not previously validated. The further inclusion of representative older patients in clinical trials combined with the use of a standardized GE could help clinicians in the decision-making process.
肿瘤学的治疗选择在不断扩大。然而，老年人在临床试验中的代表性不足，而且入组的患者往往比同龄人健康状况更好，这导致针对这一异质人群缺乏代表性证据。因此，越来越需要纳入老年患者，并对“虚弱”进行统一分类。标准化工具可以提高临床试验的质量和可比性，并有助于临床决策。本文献综述的目的是阐述在临床癌症研究中使用老年评估（GE）方法的概述。
我们对 PubMed 数据库进行了文献回顾。纳入了应用或评估明确的肿瘤患者 GE 系统的临床药理学治疗研究。检索的数据包括应用的 GE 方法、癌症类型、所研究的药物治疗、纳入的患者数量、研究类型、发表年份，以及 GE 的主要目的。更深入地描述了最常使用的 GE。
在本文献综述中，选择了 103 篇论文进行纳入。研究中最大的比例（36%，n=34）使用了明确但未经过验证的 GE 方法（特定于研究的 GE）。至少有 5 篇文献中使用的标准化 GE 方法是 G8 筛查测试（18%的纳入研究，n=17）、Balducci 评分（7%，n=7）和基于 Hurria 的老年评估（5%，n=5）。GE 的主要目的主要是评估其在药物治疗优化中的潜在作用。GE 还可作为基线和结果测量、纳入/排除标准、分层随机化的因素以及确定治疗分配的依据。
研究中使用的 GE 方法范围广泛，使得直接比较变得困难，而且许多方法的特征描述较差，或者没有经过验证。进一步将有代表性的老年患者纳入临床试验，并使用标准化的 GE，可以帮助临床医生在决策过程中做出决策。
