Department of Geriatrics, Aarhus University Hospital, Denmark.
Department of Oncology, Aarhus University Hospital, Denmark.
J Geriatr Oncol. 2024 Nov;15(8):102069. doi: 10.1016/j.jgo.2024.102069. Epub 2024 Sep 16.
Cancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer.
A single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model.
In total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45-1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49-17.5]).
Multidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population.
Registered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).
老年体弱患者的癌症管理较为复杂，因为这组患者的功能状态、合并症和预期寿命均显著下降。因此，本研究旨在探究在老年虚弱前期和虚弱期癌症患者中，肿瘤治疗联合综合老年评估（CGA）和针对性随访干预是否能提高或维持生活质量（QoL）。
这是一项单中心随机对照试验，纳入了年龄在 70 岁及以上、患有头颈部、肺部、上消化道、结肠或直肠癌症且接受非手术治疗的患者。所有患者均在门诊肿瘤诊所由多学科老年团队进行 CGA。该团队由老年病学家和专门护士组成，他们在随机分组后 90 天内提供针对性的随访访问和电话咨询。排除标准为功能状态良好的患者、转介至专门的姑息治疗或参与其他老年研究项目的患者。在认知功能正常的患者中，使用 EORTC QLQ-C30 和 QLQ-ELD-14 问卷在干预前后评估 QoL。在认知障碍患者中，使用总体 QoL-抑郁清单。采用逻辑回归模型对 QoL 的变化进行二分分析，分为改善/不变或恶化。
共纳入 363 名参与者，平均年龄为 76 岁（标准差 4.6），45%为女性。干预组中有 60%的患者 QoL 改善或不变，而对照组中有 66%（比值比：0.75 [95%置信区间（CI）：0.45-1.23]）。总体而言，疲劳和对未来担忧的减少方面出现了具有临床意义的改善。干预组在失眠症状方面有所改善，报告的角色功能下降。疾病负担方面存在差异，但无临床意义，干预组的负担增加，而对照组的负担减少（系数：9.02 [95%CI，0.49-17.5]）。
多学科老年随访并未普遍改善老年虚弱期癌症患者的 QoL。然而，特定 QoL 方面的积极变化揭示了细微的影响，需要进一步探索和更大规模的研究来验证这些观察结果。针对疲劳、失眠和情绪健康的针对性干预对于改善该人群的 QoL 至关重要。
2016 年 1 月在 ClinicalTrials.gov 注册（ID：NCT02837679）。
