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[肿瘤学中的衰弱:临床实践的更新建议]

[Frailty in Oncology: Updated Recommendations for Clinical Practice].

作者信息

Goede Valentin, Wedding Ulrich

机构信息

Abteilung für Onkologische Geriatrie, Cellitinnen-Krankenhaus St. Marien, Köln, Deutschland.

Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Germany.

出版信息

Dtsch Med Wochenschr. 2024 Aug;149(17):1009-1014. doi: 10.1055/a-2115-0583. Epub 2024 Aug 15.

Abstract

Frailty is a clinical condition associated with aging and resulting in increased risk of adverse outcomes upon exogenous or endogenous stressors. In oncology, cancer treatment itself can be a stressor event. In older cancer patients, frailty therefore not only enhances the probability of age-related health events such as institutionalization or falls, but also of treatment complications such as toxicity and interruption or discontinuation of therapy. As demonstrated by recent randomized-controlled trials conducted in older cancer patients receiving systemic treatment, the evaluation of frailty by geriatric assessment (GA) followed by an adjustment of the oncological therapy as well as targeted frailty interventions help to improve cancer treatment tolerability and feasibility. Based on these data, the American Society of Clinical Oncology (ASCO) updated the clinical practice guidelines for the assessment and management of vulnerabilities in older adults receiving systemic cancer therapy. The guideline recommends the use of a new GA-tool named 'practical geriatric assessment' (PGA) to foster the implementation of GA-based frailty assessment and management in routine cancer care. This article describes the background and key aspects of these recent advances.

摘要

衰弱是一种与衰老相关的临床状况,在外源性或内源性应激源作用下会导致不良后果风险增加。在肿瘤学领域,癌症治疗本身可能就是一个应激源事件。因此,在老年癌症患者中,衰弱不仅会增加与年龄相关的健康事件(如入住养老院或跌倒)的发生概率,还会增加治疗并发症(如毒性反应以及治疗中断或终止)的发生概率。近期针对接受全身治疗的老年癌症患者开展的随机对照试验表明,通过老年综合评估(GA)对衰弱进行评估,随后调整肿瘤治疗方案以及针对性的衰弱干预措施有助于提高癌症治疗的耐受性和可行性。基于这些数据,美国临床肿瘤学会(ASCO)更新了接受全身癌症治疗的老年人脆弱性评估和管理的临床实践指南。该指南推荐使用一种名为“实用老年综合评估”(PGA)的新型GA工具,以促进在常规癌症护理中基于GA的衰弱评估和管理的实施。本文介绍了这些最新进展的背景和关键要点。

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