Center for Cancer and Aging, City of Hope, Duarte, California, USA.
Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.
Cancer. 2024 Sep 1;130(17):3000-3010. doi: 10.1002/cncr.35333. Epub 2024 Apr 17.
Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy.
Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times-today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome-related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics.
A total of 219 patients (median [range] age 71 [65-88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible".
Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient-defined priorities and include them in decision-making.
面临多种治疗选择的老年癌症患者必须对各种结果进行优先排序。本研究评估了开始化疗的老年癌症患者的健康结果优先排序情况。
这是一项针对老年癌症患者脆弱性问题的随机试验的二次分析。患者完成了三种经过验证的结果优先排序工具：1）健康结果工具：使用视觉模拟量表对结果（生存、独立性、症状）进行优先排序；2）现在与以后工具：评估患者在三个时间点对生活质量的重视程度，即今天、1 年和 5 年后；3）态度量表：评估患者对与结果相关的陈述的同意程度。作者测量了患者对各种结果进行优先排序的比例，并评估了他们的特征。
共纳入 219 例患者（中位[范围]年龄 71[65-88]岁，68%为转移性疾病）。在健康结果工具上，60.7%的患者将生存作为首要考虑因素。患有局限性疾病的患者更倾向于选择生存作为首要目标。在现在与以后工具上，50%的患者认为当前和未来的生活质量同等重要。在态度量表上，53.4%的患者不同意“对我来说最重要的是尽可能长时间地生存，无论我的生活质量如何”这一说法；82.2%的患者同意“保持我的思维能力对我来说比尽可能长时间地生存更重要”这一说法。
尽管大多数参与者将生存作为首要考虑因素，但一些老年癌症患者会将其他结果（如认知和功能）放在首位。临床医生应该了解患者的优先事项，并将其纳入决策过程。
