老年综合评估在老年血液系统肿瘤患者中的研究进展

随着老年人血液系统肿瘤发病率的逐年升高,如何更好地评估老年血液肿瘤患者对化疗的耐受性是困扰临床医师的问题.最近老年综合评估开始用于老年血液肿瘤患者,研究发现老年综合评估可以判断患者预后,预测患者对治疗的耐受性,并有可能指导治疗决策.文章对国内外老年综合评估在血液肿瘤的研究现状进行综述.     

综合老年评估在老年肿瘤中的临床应用

随着社会老龄化,老年肿瘤的处理成为一个主要的社会健康问题.然而,有关老年肿瘤的治疗耐受、疗效与预后的相关资料仍十分缺乏.综合老年评估是近年来发展起来的一项多学科、多维的老年肿瘤寿命及发病风险的评估系统,其对老年肿瘤患者制定合理的治疗方案,提出降低发病和死亡风险的干预措施等都有重要的意义.     

综合老年学评估在血液系统肿瘤中的应用进展

综合老年学评估(comprehensive geriatric assessment,CGA)是指对老年人的机体功能状况、心理状态、社会支持、用药情况和合并症等多方面进行评估.老年血液系统肿瘤治疗复杂,CGA可用于筛查患者的衰弱情况,预测预后、治疗相关毒性以及指导个体化治疗,目前在老年癌症患者中的应用越来越广泛.本文就...     

老年肺癌的手术治疗

 手术通常为肺癌患者首选的治疗方式,但其风险也随年龄增加而有所增大。对老年人肺癌治疗应全方位评估手术治疗的风险以使患者获得最好的治疗效果。通常的术前评估包括肿瘤分期、心肺功能评估、营养状况评估等,常采取的手术方案包括局部切除和电视辅助胸腔镜手术等。     

重视老年癌痛患者的药物止痛治疗

临床上针对老年癌患者的止痛治疗目前还存在一些障碍,包括病因及病情复杂、评估不足、实际生理年龄变化认知不足以及阿片成瘾恐惧。因此,治疗中应重视老年患者器官老化、合并疾病等变化对疼痛评估及治疗的影响,重视老年癌痛患者的综合评估,重视止痛药的合理选择及个体化剂量调整。     

老年非小细胞肺癌治疗进展

非小细胞肺癌(NSCLC)被认为是一个典型老年疾病,因老年人生理的特殊性,年龄大于70岁的患者往往被排斥在临床研究之外,缺乏多中心临床随机对照研究,目前尚无肯定的标准治疗。现综述近年来老年NSCLC治疗临床研究,指出单独年龄因素不是影响老年NSCLC患者手术、放疗及化疗的绝对禁忌证。     

老年非小细胞肺癌治疗进展

非小细胞肺癌（NSCLC）被认为是一个典型老年疾病,因老年人生理的特殊性,年龄大于70岁的患者往往被排斥在临床研究之外,缺乏多中心临床随机对照研究,目前尚无肯定的标准治疗。现综述近年来老年NSCLC治疗临床研究,指出单独年龄因素不是影响老年NSCLC患者手术、放疗及化疗的绝对禁忌证。     

老年肿瘤评估及决策新体系

中国已进入老龄化社会,而恶性肿瘤即是衰老疾病的一种。恶性肿瘤在老年人群中发病率普遍偏高,衰老和肿瘤存在一定的内在联系。老年肿瘤患者具有其独特性,如伴随疾病、多重用药、虚弱状态、认知障碍等,限制了常规抗肿瘤治疗模式在老年这一特殊人群中的应用。故而,老年肿瘤患者的治疗决策很大程度上依赖于完善的动态老年评估,完善的评估可预测老年肿瘤患者是否可从常规抗肿瘤治疗模式中获益。此外,因伦理要求,多数临床研究设置了入组年龄上限,基于此所获之临床证据难以指导高龄肿瘤患者的临床实践,故亟需在该领域有所创新。本文就上述领域的研究现状及发展趋势进行综述,并针对老年肿瘤人群的全面评估和精准临床决策进行讨论。      

综合性老年评估在异基因造血干细胞移植中的研究进展

近年来,异基因造血干细胞移植(allo-HSCT)作为血液系统疾病的一种有效治疗方式,在老年患者中的应用逐渐增加.除年龄外,移植前体能状态、共患病情况、营养状况、认知功能、心理状态等也都会影响老年患者的预后.综合性老年评估(CGA)能够更好地发现患者的健康受损情况,其评估结果也与预后密切相关.因此,CGA在需要接受allo-HSCT的老年患者中得到了越来越多的重视.文章主要介绍了CGA的建立及其在老年患者allo-HSCT中的应用.     

合理用药 控制疼痛 老年肿瘤的综合治疗

老年肿瘤患者的综合评价对于老年肿瘤患者接受治疗前,进行科学准确的机体综合状态评价是必须的。目前国际上推荐的综合老年状态评估体系通过对老年个体的活动能力、合并疾病状态、认知能力、心理状态、社会支持、营养状态、既往疾病史等指标对老年患者进行综合评价。具体包括患者日活动度、应用生活工具情况、合并其他脏器疾病情况、社会和家庭对患者经济和心理的支持程度、药物代谢和药物疗效的特点等诸多方面指标。     

Aging, frailty, and chemotherapy.

BACKGROUND: In many cases, elderly individuals have not been offered life-saving interventions due to the assumption that these treatments would be too toxic to tolerate. METHODS: This article offers an overview of the biology of aging, reviews the assessment of an individual's physiologic age, and explores the medical definition of frailty and its implications in cancer treatment. RESULTS: The definition of frailty is controversial. Rather than chronologic age, a more accurate assessment relies on individual estimates of life expectancy and functional reserve, including serum levels of interleukin 6 and D-dimer, the levels of a number of inflammatory cytokines, and the circulating level of C-reacting protein. Decision making for optimal cancer treatment in the older-aged patient benefits from a comprehensive geriatric assessment, a functional test, and a laboratory evaluation to determine a patient's life expectancy and functional reserve. CONCLUSIONS: Most older patients appear to benefit from cancer treatment to an extent comparable to that of younger individuals, and only a minority of these patients should be excluded from treatment due to reduced tolerance.     

Estimating Radiation Therapy Toxicity and Tolerability with Comprehensive Assessment Parameters in Geriatric Cancer Patients

Cancer prevalance and incidence is increasing with aging of populations and age is a critical factor indecision-making for anti-cancer treatment. However it is believed that chronological age is not enough to guidemanagement in elderly cancer patients. Multidisciplinary evaluation and comprehensive geriatric assessmenthas gained importance regarding the treatment selection especially for definitive anti-cancer therapy recently.We here aimed to analyse the effect of the comprehensive geriatric assessment parameters on radiotherapytoxicity and tolerability in a series of geriatric cancer patients in Turkey.     

老年肺癌综合评估方法的研究进展

肺癌已是老年人死亡率最高的疾病之一。晚期老年肺癌患者往往合并营养不良、衰弱、多重用药、精神心理痛苦等问题,这些问题成为制约老年肺癌患者生活质量的重要因素。老年综合征和老年综合评估是解决老年人临床常见问题的策略和方式,是老年医学核心技术之一。应用合适的评估方法能够有效筛查老年患者潜在问题,同时加以合理应对可改善其生活质量。本文拟对现有的综合评估方法在老年肺癌患者中的应用及对这些问题的解决方案加以论述,以期为临床进行老年肺癌患者的综合管理,提高生存质量提供理论依据。     

Treatment of elderly patients with stage IV non-small-cell lung cancer

Every thoracic oncologist could be considered a geriatric oncologist as the median age of presentation with metastatic non-small-cell lung cancer is 71 years. Subgroup analyses and population-based studies suggest similar benefits to treatment of the fit elderly compared with younger patients. In 2011, a Phase III trial demonstrated the superiority of doublet chemotherapy over single-agent therapy for the elderly. For elderly patients there has been sufficient time to fully express any genetic predispositions, and the cumulative wear and tear, including the effects of cigarette smoke, can degrade performance status and impair organ function, leading some older patients to be less fit. Comprehensive geriatric assessment can augment the standard examination in defining the strengths and weakness of the elderly patient who is considering chemotherapy. In the future, biochemical assessment of physiologic age may further aid this assessment.     

The Role of Adjuvant Therapy in the Elderly

Colorectal cancer is the third commonest cancer and second commonest cancer killer in the USA. With a median age at diagnosis of 72 years, it largely affects the elderly population. However, there is a lack of objective data with which to answer clinically relevant questions regarding adjuvant therapy in the geriatric patient population because mainly younger patients are enrolled in clinical trials. Elderly patients are undertreated in the adjuvant setting owing to multiple factors, including physician decision and patient preference. Older patients have different tumor biology, physiologic factors, and social situations to consider in comparison with younger patients. Thus, geriatric patients require more thorough assessment of their functional status and existing medical conditions as they are at risk of increased toxicities from chemotherapy and their ongoing treatment requires vigilance. Elderly patients do benefit from adjuvant chemotherapy, although subgroup analyses show that many do not derive incremental benefit from the addition of oxaliplatin to 5-fluorouracil therapy.     

Palliative Care of Cancer in the Older Patient

The scope of palliative care includes goal setting, symptom management, and care of the care giver. Palliative care is essential for patient-centered care of the older cancer patients. The diversity of this population in terms of life expectancy, treatment tolerance, function, disability, and social support mandates personalized treatment plans. The assessment of physiologic age is currently based on a comprehensive geriatric assessment (CGA). A number of biologic markers of aging including the inflammatory index, the genomic clock, the expression of p16INKa4, and the circulating levels of vitamin D may complement the CGA and fine-tune the determination of physiologic age. Goal setting in older patients may be complicated by communication difficulties related to hearing, cognition, expectation, and culture. Cancer-related pain is a major hindrance to the maintenance of functional independence and fatigue is harbinger of disability and death. The article explores the assessment and the management of the most common and debilitating symptoms in older cancer patients.     

Comprehensive Geriatric Assessment and Adjustment of Cancer Treatment

A comprehensive geriatric assessment predicts classical oncologic outcome; however, evidence of comprehensive geriatric assessment-tailored treatment is still missing. Research is needed to drive evidence-based change in oncologic treatment and recognition of the potential value of geriatricians on an oncology team.McCleary and colleagues reported on the feasibility of computer-based cancer-specific geriatric assessment (CSGA). It is very positive and promising that the proportion of elderly patients completing CSGA at baseline and follow-up increased to 97%. The authors stated that although CSGA added information to clinical assessment, it did not currently affect clinical decision making [1].Does a comprehensive geriatric assessment (CGA), either computer based or with paper and pencil, lead to adjustments in cancer treatment? The clinical question asked is whether oncologists know how to adjust cancer treatment based on the results of a CGA. The answer is, not yet. There is a lack of data on adjustments of cancer treatment based on CGA.Why are these data lacking despite a decade of research in geriatric oncology? CGA has been introduced in geriatric oncology to predict the outcome of elderly patients and has not yet been evaluated to adjust cancer treatment. Furthermore, outcome of cancer treatment has classically been evaluated using toxicity, progression-free survival, and mortality, not including CGA-related outcome. The impact of cancer treatment on functional and cognitive status has not yet been defined in large cohorts of elderly patients, whereas classical oncologic outcome parameters are assessed prior to and after cancer treatment. Consequently, we emphasize the importance of incorporating CGA outcome parameters (e.g., functional and cognitive parameters) alongside classical oncologic outcome during follow-up. These CGA outcome parameters should be easily measured (i.e., computer-based) and objective.CGA predicts classical oncologic outcome [2, 3]; however, evidence of CGA-tailored treatment is still missing. Research should focus on phenotyping elderly cancer patients and follow-up during and after treatment in order to define possible causal relationships. When a causal relationship between a typical geriatric parameter—one that would have been unnoticed without a CGA—and oncologic outcome is established, interventions can be targeted. In future studies, treatment regimens of full-dose systemic therapy and adjusted schedules should be compared. Ultimately, this should lead to an evidence-based change in oncologic treatment and recognition of the potential value of geriatricians on an oncology team.     

Geriatric assessment in elderly patients with prostate cancer

As a result of demographic evolution, oncologists will treat more and more elderly patients with prostate cancer. Aging is frequently associated with the coexistence of several medical complications that can increase the complexity of cancer treatment decision-making. Unfortunately, clinical oncologists need to be more familiar with the multidimensional assessment of elderly patients. To acquire this skill, we implemented a multidimensional geriatric assessment program at our cancer center. This instrument prospectively assessed 60 elderly patients with prostate cancer. Herein, we describe geriatric aspects detected in our patient sample and report treatment options proposed to elderly patients with prostate cancer at different disease stages. The minimal comprehensive geriatric assessment (mini-CGA) procedure revealed that 66% of our patient population was dependent in one or more of the Katz Activities of Daily Living and 87% were dependent in 1 or more of the Lawton Instrumental Activities of Daily Living; all patients had significant comorbidity according to the Cumulative Illness Rating Scale-Geriatrics, 75% having at least one severe comorbidity. We identified 19 cases of drug interaction. We also observed that half of these patients had a risk of falling and some physical disability; 45% had cognitive disorders requiring more investigation; one third had depressive symptoms. Finally, 65% of the patients were either malnourished or at risk of malnutrition. Many of these problems were unknown before the mini-CGA processing and may interfere with cancer and cancer treatment. Thus, the correct management of elderly patients with cancer requires comprehensive geriatric assessment as well as relevant disease staging at diagnosis. This approach will help us to propose the most appropriate treatment with the main aim of preserving quality of life.     

Geriatric assessment and comorbidity

Elderly persons, a rapidly growing population segment, have an increased incidence of cancer. The older cancer patient's clinical evaluation and treatment is influenced by conditions such as disabilities, comorbidity, and functional status, along with tumor type and stage. These conditions and other geriatric syndromes can be identified by comprehensive geriatric assessment to guide therapy and affect prognosis and quality of life. Comprehensive geriatric assessment involves the medical, functional, affective, social, spiritual, and environmental assessments. The medical assessment, which includes a nutrition, vision, hearing, continence, gait and balance, and cognition evaluation, can provide additional information to performance status and comorbidity. Although there are many assessment domains using several instruments, comprehensive geriatric assessment can be focused and efficient, especially with a multidisciplinary team of nurses, social workers, pharmacists, and other personnel. Comorbid illnesses may have complex interactions, with the underlying cancer influencing cancer diagnosis, disease course, treatment-related side effects, and mortality. Many instruments are available for comorbidity measurement, and retrospective studies in elderly cancer cohorts have shown comorbidity to influence survival. However, the ultimate aim would be to use comorbidity and comprehensive geriatric assessments prospectively in the older cancer patient to help predict the suitability and success of treatment with various antineoplastic modalities.