Roche R J, Forman W B, Rhyne R L
Internal and Family Medicine Association, Albuquerque, New Mexico, USA.
Cancer Pract. 1997 Mar-Apr;5(2):81-6.
The authors evaluate the role of cognitive, functional, and affective geriatric assessment measures in elderly cancer patients, and analyze the associations between these factors, stage of malignancy, and cancer treatment choices.
Fifty consecutive patients older than 65 years of age who were referred to the Geriatric Oncology Clinic at the University of New Mexico Health Sciences Center in Albuquerque were evaluated using standard geriatric assessment tools. Each person underwent a complete history and physical examination. An extensive chart review established the type of cancer, stage at diagnosis, and treatment modalities used. The Karnofsky performance status scale score also was determined at this initial evaluation.
The group had a mean age of 74.9 years; 60% were women and 40% were men. The most common cancers were breast (28%) and prostate (16%). Fifty-two percent of the patients had localized disease and 48% had distant disease. Seventy-four percent had received treatment by the time of the initial assessment, with 62% undergoing combination therapy. The most common noncancer diagnoses were cardiovascular disease, hypertension, and osteoarthritis. Scores on standardized measures indicated that the majority of patients were independent. Those who did not receive treatment were more functionally impaired than those who received treatment. Twenty-seven percent of the sample were impaired cognitively and 24% were depressed. There were no statistical differences in functional, cognitive, or affective status between stages of disease for specific malignancies.
Age alone is a poor predictor of outcome in cancer treatment and is an inappropriate factor by which to exclude persons with cancer from clinical trials. Treatment decisions based on age alone may lead to inadequate treatment. In this report, functional dependence was more prevalent in nontreated patients and was unrelated to the stage of disease. These results support the need for formal geriatric assessment, including measures of cognitive, functional, and affective status, in elderly persons with cancer. Further studies on the role of functional, cognitive, and affective status at the time of cancer diagnosis, as well as how these parameters might alter treatment decisions, are warranted. In addition, further investigation to identify which of these multiple variables influence treatment outcome are needed.
作者评估认知、功能和情感方面的老年评估措施在老年癌症患者中的作用，并分析这些因素、恶性肿瘤分期及癌症治疗选择之间的关联。
对连续50例年龄大于65岁且转诊至阿尔伯克基新墨西哥大学健康科学中心老年肿瘤诊所的患者，使用标准老年评估工具进行评估。每位患者均接受完整的病史询问和体格检查。通过广泛查阅病历确定癌症类型、诊断时的分期及所采用的治疗方式。在初次评估时还确定了卡氏功能状态量表评分。
该组患者的平均年龄为74.9岁；60%为女性，40%为男性。最常见的癌症是乳腺癌（28%）和前列腺癌（16%）。52%的患者患有局限性疾病，48%患有远处疾病。74%的患者在初次评估时已接受治疗，其中62%接受了联合治疗。最常见的非癌症诊断为心血管疾病、高血压和骨关节炎。标准化测量得分表明大多数患者具有独立性。未接受治疗的患者在功能上比接受治疗的患者受损更严重。27%的样本存在认知障碍，24%存在抑郁。特定恶性肿瘤不同疾病分期之间在功能、认知或情感状态方面无统计学差异。
仅年龄并不能很好地预测癌症治疗的结果，且将癌症患者排除在临床试验之外是不恰当的。仅基于年龄做出治疗决策可能导致治疗不足。在本报告中，功能依赖在未接受治疗的患者中更为普遍，且与疾病分期无关。这些结果支持对老年癌症患者进行正式的老年评估，包括认知、功能和情感状态测量的必要性。有必要进一步研究癌症诊断时功能、认知和情感状态的作用，以及这些参数如何改变治疗决策。此外，还需要进一步研究确定这些多个变量中哪些会影响治疗结果。
