老年综合评估在老年肿瘤患者中应用的研究进展

年龄超过65岁的老年人恶性肿瘤的发病率及死亡率近年来明显升高。老年人是一个异质性群体,自然年龄与其生理状态不一致。为了确保对老年肿瘤患者采取的治疗措施安全有效,肿瘤科医生应全面了解老年患者的生理及功能状态。老年综合评估是一项多学科多维度的有关老年患者健康和功能状态的评估系统。现已证明它对发现老年肿瘤患者潜在的健康问题、预测治疗相关不良反应、评估预后及治疗效果,帮助制定肿瘤治疗决策有重要意义。     

衰弱筛查工具在老年肿瘤患者中应用的研究进展

摘 要：衰弱作为近年来老年医学领域研究的热点之一，被认为是导致老年肿瘤患者健康状况存在异质性的重要原因，成为老年肿瘤患者治疗前评估的重要组成部分。衰弱筛查工具是一种简短的评估，旨在帮助临床医生识别需要进一步老年综合评估(comprehensive geriatric assessment，CGA)的患者，可以更好地了解患者的健康状况和个体生存率，并指导临床干预措施。全文就衰弱筛查工具在老年肿瘤患者中应用的研究进展作一综述，以期为评估该人群的健康状况提供科学依据。     

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.     

老年肿瘤患者综合评估的现状

肿瘤与年龄密切相关，近60％的肿瘤发生于65岁及以上人群，80％的肿瘤死亡发生于这一年龄组。65岁及以上人群肿瘤的发病率比65岁以下人群高近10倍，其肿瘤死亡率是65岁以下人群的16倍。这与老年肿瘤患者的生理特点及治疗的复杂性有关，因此如何更好地治疗老年肿瘤患者已经成为肿瘤学领域和老年病学领域共同关心的内容。     

165例肿瘤患者用药ADR报告的分析

目的分析各种因素对肿瘤患者用药后引发的不良反应(ADR)及特点。方法对南通市肿瘤医院2011年1月至12月各科收集到的165例肿瘤患者用药ADR报告信息进行汇总,从患者年龄、性别、给药途径、药物种类及ADR的临床表现等方面进行回顾分析。结果 165例中,女性患者居多(54.5%),41～60岁患者多(41.2%);在给药方式方面,静脉用药更易引发ADR;在用药种类方面,抗感染类药物引起患者ADR的机率最高(47.4%)。消化系统损害所占比例最高,达30.6%,主要表现为恶心、呕吐、腹泻等。结论肿瘤患者用药后ADR的发生率高,应重视对ADR的监测工作,做好预防及处理。     

老年肿瘤患者的化疗进展

老年肿瘤患者的化疗是临床上比较有争议的问题,虽然存在很大数量的这类患者,但却没有具有针对性的治疗指南。这类患者体力状态不佳,对化疗耐受较差,因而既往多采用保守的对症支持治疗。随着化疗新药物、新方案的出现,临床医生开始尝试单药治疗、分子靶向药物治疗和多药序贯联合化疗等新的治疗策略,提高了患者对化疗的耐受,使患者从化疗中获益。随着全球老龄化社会的到来,老年肿瘤患者的数量大幅度增加。老年肿瘤患者往往由于体力状态不佳等原因不能耐受化疗,因此国内外肿瘤临床医生都面临着有大量这类特殊患者但缺乏相关治疗指南的尴尬局面…     

老年肿瘤患者营养评估及影响因素研究进展

我国人口老龄化形势严峻,罹患肿瘤的老年患者不断增加,伴随而来的老年肿瘤住院患者逐年上升,老年肿瘤患者作为特殊群体获得临床学者的广泛关注。肿瘤作为一种慢性消耗性疾病, 其本身及其治疗的不良反应,会持续大量的消耗肌肉、脂肪组织。老年肿瘤患者合并症多、病情比较复杂, 治疗周期相对较长, 营养风险及营养不良的发生概率较高。营养不良会增加老年肿瘤患者并发症发生风险、延长住院时间、增加医疗费用,对患者的生存质量造成严重不良影响。了解老年肿瘤患者营养评估内容,采取合适的营养筛查和评估方法,同时了解引起老年肿瘤患者营养风险和营养不良的影响因素,对老年肿瘤患者具有重要意义。 本文从老年肿瘤患者营养评估内容、营养筛查与评估方法的选择、营养不良影响因素等方面进行讨论。以期全面提高对老年肿瘤患者营养情况的认识,选择合适的营养评估内容,筛选最佳的营养评估工具,根据影响因素采取针对性措施,更好地提高老年肿瘤患者的营养状况,提高预后和生活质量。     

肿瘤患者用药误区

世界卫生组织（WHO）最新数据显示,到2020年前,全球癌症发病率将增加50％,即每年将新增1500万癌症患者。不仅如此,癌症的死亡人数也在全球迅猛上升,2007年全球共有760万人死于癌症,2030年这个数字可能会增至1320万。而且,全球20％的新发癌症病人在中国,24％的癌症死亡病人在中国。目前我国每死亡5人,即有1人死于癌症;而在0～64岁人口中,每死亡4人,即有1人死于癌症。     

老年肿瘤患者合并心血管疾病的研究概况

0 引言 目前关于老年人的定义尚未完全统一.WHO规定:60～74岁为年轻老人;75～89岁为老年人;90岁以上为非常老的老年人或长寿老年人.中华医学会老年学会根据我国实际情况于1982年将老年人年龄标准划分为60岁以上.     

老年肿瘤患者应该知道自己的病情么?

究竟要不要告知肿瘤患者真实的病情?一直是家属和医护人员所面临的难题和困境。人们通常会担心告诉肿瘤患者真实病情可能引发患者本人产生心理问题,进而拒绝接受治疗。有的患者家属甚至认为,告诉真相会对患者造成伤害和打击。肿瘤'长在患者自己的身上',患者有权知道自己的真实病情,这是国际上对患者基本权力的普遍共识。经验证明,绝大多数患者都希望知道他们所患疾病的全部信息,都不愿人们对他们隐瞒真相。     

Chemotherapy in elderly patients with colorectal cancer

Background:Colorectal cancer is usually diagnosed in patients around 70 years of age. With a continuous increase in life expectancy we may expect a higher number of elderly patients in the future. Because patients above 70 or 75 years are often excluded there is uncertainty as to what extent systemic adjuvant and palliative treatment should be offered to elderly patients. Methods:We reviewed the available literature on adjuvant and metastatic colorectal cancer in order to identify reports on elderly patients treated within chemotherapy trials. Results:Only about 20% of patients entering clinical trials belong to the age group of over 70 years and represent the minority of the very fit patients. Compared to their younger counterparts 5-FU-based treatment appears to be equally effective and more toxic according to some reports. Data regarding raltitrexed, oral fluoropyrimidines, topoisomerase I inhibitors or DACH-platin derivates are limited but suggest no age-specific differences in activity or toxicity. Conclusions:Elderly patients should not be excluded from clinical trials and studies in unfit elderly patients are warranted. Elderly patients need more attention regarding their functional, social and mental status. Fit elderly patients should be offered adjuvant or palliative chemotherapy.     

Adjuvant chemotherapy in elderly patients with pancreatic cancer

Background:

Adjuvant chemotherapy improves survival for patients with resected pancreatic cancer. Elderly patients are under-represented in Phase III clinical trials, and as a consequence the efficacy of adjuvant therapy in older patients with pancreatic cancer is not clear. We aimed to assess the use and efficacy of adjuvant chemotherapy in older patients with pancreatic cancer.

Methods:

We assessed a community cohort of 439 patients with a diagnosis of pancreatic ductal adenocarcinoma who underwent operative resection in centres associated with the Australian Pancreatic Cancer Genome Initiative.

Results:

The median age of the cohort was 67 years. Overall only 47% of all patients received adjuvant therapy. Patients who received adjuvant chemotherapy were predominantly younger, had later stage disease, more lymph node involvement and more evidence of perineural invasion than the group that did not receive adjuvant treatment. Overall, adjuvant chemotherapy was associated with prolonged survival (median 22.1 vs 15.8 months; P<0.0001). Older patients (aged ⩾70) were less likely to receive adjuvant chemotherapy (51.5% vs 29.8% P<0.0001). Older patients had a particularly poor outcome when adjuvant therapy was not delivered (median survival=13.1 months; HR 1.89, 95% CI: 1.27–2.78, P=0.002).

Conclusion:

Patients aged ⩾70 are less likely to receive adjuvant therapy although it is associated with improved outcome. Increased use of adjuvant therapy in older individuals is encouraged as they constitute a large proportion of patients with pancreatic cancer.     

老年晚期癌症患者的临终关怀

临终关怀与老年人关系密切，老年癌症患者是临终关怀的主要对象，这也是姑息医学的主要内容。作为一门新兴学科，本文对临终关怀的概念、目的及其在老年晚期癌症患者中的实施作一综述。     

老年晚期癌症患者的临终关怀

临终关怀与老年人关系密切,老年癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容.作为一门新兴学科,本文对临终关怀的概念、目的及其在老年晚期癌症患者中的实施作一综述.     

老年肿瘤患者开胸手术术后镇痛研究进展

开胸手术对老年肿瘤患者创伤巨大,术后的疼痛可诱发机体的一系列不良反应,同时限制了患者肺功能的恢复.目前国内外已有多种方法用于肿瘤患者开胸手术术后镇痛,例如静脉镇痛、硬膜外镇痛、椎旁神经阻滞、肋间神经阻滞、肋间神经冰冻法、胸膜间镇痛、鞘内注射吗啡镇痛等,其各有适应症、禁忌症和不良反应.胸段胸膜外镇痛和阿片类药物联合应用是目前开胸手术后镇痛的金标准,多模式镇痛是主要发展趋势.     

吉西他滨治疗高龄晚期非小细胞肺癌

目的:观察吉西他滨治疗高龄晚期非小细胞肺癌的疗效,并与同期单纯支持治疗的患者比较,以探讨高龄晚期非小细胞肺癌的治疗方案。方法:吉西他滨组21例,采用吉西他滨单药化疗,剂量为1250mg/m2,静脉滴注,第1、8天用药,每21天为1周期,共4周期。对照组23例不用任何化疗,单纯支持对症治疗。结果:吉西他滨组总有效率为28.6%,其中PR6例,SD12例,PD3例。对照组无CR和PR者。吉西他滨组中位缓解期6.3个月。吉西他滨组和对照组中位肿瘤进展时间分别为5.8和2.6个月,中位生存时间分别为12.8和4.6个月(P<0.01);1年生存率分别为46.6%和9.2%(P<0.01)。吉西他滨组KPS、体重增加和临床症状改善情况均显著高于对照组(P<0.01)。毒副反应方面吉西他滨组12例(57.1%)出现Ⅰ、Ⅱ级血小板减少,7例(33.3%)出现Ⅰ、Ⅱ级白细胞下降,未见Ⅲ、Ⅳ级毒性反应。少数患者血红蛋白下降Ⅰ度,恶心呕吐Ⅰ/Ⅱ度。结论:吉西他滨单药治疗高龄晚期非小细胞肺癌是安全有效的。     

Safety and outcome of definitive chemoradiotherapy in elderly patients with oesophageal cancer

Little is known about chemoradiotherapy (CRT) in elderly patients with a locally advanced oesophageal cancer (OC). The aim of our study was to evaluate the tolerance and the outcome of elderly patients older than 70 years treated with CRT for a non-metastatic OC. Chemoradiotherapy was based on radiotherapy combined with a cisplatin-based chemotherapy. Clinical complete response (CCR) to CRT was evaluated on upper digestive endoscopy and computed tomography scan 6–8 weeks after CRT completion. One hundred and nine consecutive patients were included. A CCR was observed in 63 patients (57.8%) and 2-year survival was 35.5%. Adverse events ⩾grade 3 were observed in 26 (23.8%) patients. Chemotherapy dose reduction, chemotherapy delays more than 1 week, and treatment discontinuation were observed in 33 (30.3%), 45 (41.3%), and 17 patients (15.6%), respectively. Comorbidity index according to Charlson score was significantly associated with treatment tolerance. In multivariate analysis, a CCR to CRT (P<0.01), a dose of radiotherapy ⩾80% (P=0.02), and a Charlson score ⩽2 (P=0.046) were identified as independent prognostic factors of overall survival. These results suggest that CRT could be considered as an effective treatment without major toxicity in elderly patients with OC.