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老年医学评估和管理干预可有效降低癌症治疗的毒性作用
作者:小柯机器人 发布时间:2021/11/7 0:53:08

美国罗切斯特大学医学中心Supriya G Mohile团队研究了癌症治疗毒性作用的老年医学评估和管理评估对预后的影响。该研究于2021年11月3日发表于《柳叶刀》杂志上。

老年晚期癌症患者治疗毒性作用的风险很高。老年医学评估测评了与老年相关的领域并指导管理。课题组研究了老年评估干预是否可减少接受高风险治疗(如化疗)的老年晚期癌症患者的严重毒性作用。

在这项分组随机试验中,研究组招募70岁及以上的不可治愈的实体瘤或淋巴瘤患者,至少有一个受损的老年评估领域,且正在开始新的治疗方案。将美国40个社区肿瘤实践群集按1:1随机分配,分别接受肿瘤医生量身定制的老年评估总结和管理建议进行干预,或接受没有肿瘤医生提供老年评估总结和管理建议的常规护理。主要结局为3个月以上发生3-5级毒性作用(基于国家癌症研究所不良事件通用术语标准第4版)的患者比例。实习人员前瞻性地观察毒性作用。

2014年7月29日至2019年3月13日,研究组共纳入718例患者,平均年龄为77.2岁,311名(43%)为女性。老年评估区域损伤的平均数量为4.5个,两组之间没有显著差异。与常规护理组(3%)相比,干预组中黑人患者多于其他种族(11%),且曾接受过化疗的患者也较多,分别为30%和22%。干预组中出现3-5级毒性反应的患者占51%,显著低于常规治疗组的71%。干预组患者在3个月内跌倒发生率为12%,显著低于常规护理组的21%,但停药次数显著多于常规护理组。

研究结果表明,针对老年晚期癌症患者的老年评估干预降低了癌症治疗的严重毒性作用。老年评估与管理应整合到老年晚期癌症患者和老年相关疾病患者的临床护理中。

附:英文原文

Title: Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study

Author: Supriya G Mohile, Mostafa R Mohamed, Huiwen Xu, Eva Culakova, Kah Poh Loh, Allison Magnuson, Marie A Flannery, Spencer Obrecht, Nikesha Gilmore, Erika Ramsdale, Richard F Dunne, Tanya Wildes, Sandy Plumb, Amita Patil, Megan Wells, Lisa Lowenstein, Michelle Janelsins, Karen Mustian, Judith O Hopkins, Jeffrey Berenberg, Navin Anthony, William Dale

Issue&Volume: 2021-11-03

Abstract:

Background

Older adults with advanced cancer are at a high risk for treatment toxic effects. Geriatric assessment evaluates ageing-related domains and guides management. We examined whether a geriatric assessment intervention can reduce serious toxic effects in older patients with advanced cancer who are receiving high risk treatment (eg, chemotherapy).

Methods

In this cluster-randomised trial, we enrolled patients aged 70 years and older with incurable solid tumours or lymphoma and at least one impaired geriatric assessment domain who were starting a new treatment regimen. 40 community oncology practice clusters across the USA were randomly assigned (1:1) to the intervention (oncologists received a tailored geriatric assessment summary and management recommendations) or usual care (no geriatric assessment summary or management recommendations were provided to oncologists) by means of a computer-generated randomisation table. The primary outcome was the proportion of patients who had any grade 3–5 toxic effect (based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4) over 3 months. Practice staff prospectively captured toxic effects. Masked oncology clinicians reviewed medical records to verify. The study was registered with ClinicalTrials.gov, NCT02054741.

Findings

Between July 29, 2014, and March 13, 2019, we enrolled 718 patients. Patients had a mean age of 77·2 years (SD 5·4) and 311 (43%) of 718 participants were female. The mean number of geriatric assessment domain impairments was 4·5 (SD 1·6) and was not significantly different between the study groups. More patients in intervention group compared with the usual care group were Black versus other races (40 [11%] of 349 patients vs 12 [3%] of 369 patients; p<0·0001) and had previous chemotherapy (104 [30%] of 349 patients vs 81 [22%] of 369 patients; p=0·016). A lower proportion of patients in the intervention group had grade 3–5 toxic effects (177 [51%] of 349 patients) compared with the usual care group (263 [71%] of 369 patients; relative risk [RR] 0·74 (95% CI 0·64–0·86; p=0·0001). Patients in the intervention group had fewer falls over 3 months (35 [12%] of 298 patients vs 68 [21%] of 329 patients; adjusted RR 0·58, 95% CI 0·40–0·84; p=0·0035) and had more medications discontinued (mean adjusted difference 0·14, 95% CI 0·03–0·25; p=0·015).

Interpretation

A geriatric assessment intervention for older patients with advanced cancer reduced serious toxic effects from cancer treatment. Geriatric assessment with management should be integrated into the clinical care of older patients with advanced cancer and ageing-related conditions.

DOI: 10.1016/S0140-6736(21)01789-X

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01789-X/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet