关于老年肿瘤学与老年肿瘤康复事业的中外对话——根据一项回顾性研究分析开展老年肿瘤综合评估的意义  

Analysis of Decision-making Process According to Performance Status and Comprehensive Geriatric Assessment in Elderly Cancer Patients

作　　者：薛冬 许轶琛 蒋姗彤 孙红 李元青 李占东 王薇 王珂 张伟 李萍萍 

机构地区：北京大学肿瘤医院暨北京市肿瘤防治研究所/中西医结合暨老年肿瘤科/恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《世界科学技术-中医药现代化》2015年第12期2451-2457,共7页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：2014年首都卫生发展科研专项“自主创新”项目（2014-2-2152）：老年晚期非小细胞肺癌患者综合评估及生存获益的临床研究,负责人：薛冬.

摘　　要：目的：本研究通过对老年肿瘤住院患者进行回顾性分析，详细记录患者治疗计划和实际接受治疗的符合情况，并分析其改变治疗计划的原因，讨论单纯以体力状况评分（PerformanceStatus，PS）作为患者治疗决策主要制定依据存在的问题及开展老年综合评估（ComprehensiveGeriatricAssessment，CGA）的必要性。方法：纳入2009年9月-2011年8月期间于北京大学肿瘤医院中西医结合暨老年肿瘤科病区，65岁以上的老年肿瘤住院患者，根据其病例记录，设计临床研究（ClinicalResearchForms，CRF）表格。记录入组患者住院期间主要依据体力状况PS评分所制定的相应治疗计划（标准治疗、个体化治疗／减量化疗或口服靶向药物治疗、最佳支持治疗）以及患者最终完成的治疗方案，将其结果分为3类：①按计划实施；②不能按照原计划实施，需调整治疗方案，即减量化疗或更改为口服靶向药物等；③不能按计划接受治疗或终止治疗。结果：166例老年肿瘤住院患者纳入本项研究。年龄65-94岁，平均年龄73．28岁。PS≤2分者143例（占86．1％，143／166），给予常规化疗或靶向治疗或单纯中药治疗；PS=3-4分者23例（占13．9％，23／166）给予最佳支持治疗。治疗计划与实际治疗相吻合者占74．7％（124／166）；在不能按照计划给予治疗的42例患者中，需调整（减量化疗或更改为口服靶向药物等）治疗方案者11例，其中，PS评分≤2者9例；不能耐受治疗或终止治疗者31例，其中，PS评分≤2者22例。在这42例患者中，36例（占85．7％，36／42）具有一种以上的内科基础病，25例（占59．5％，25／42）具有两种或两种以上的内科基础病；在吻合原方案治疗组中，85例患者具有一种以上内科基础病（占68．5％，85／124），两组进行合并症数量的比较，差异具有显著统计学意义（P〈0．05o结论：以单纯PThis study was aimed to identify the reasons associated with changes in planned cancer treatment and to reassert the role of comprehensive geriatric assessment （CGA） instead of performance status （PS） in therapeutic decision-making for elderly patients with cancer. In the study, a retrospective analysis of clinical data collected from consecutive cancer patients who attended the inpatient geriatric oncology unit in Beijing Cancer Hospital within and more than 65 years old from Sep. in 2009 to Aug. in 2011 was performed. Clinical Research Forms （CRFs） were filled and input to the database. The planned cancer treatment （standard treatment, target therapy and palliative care） according to PS was recorded. Changes of the final treatment were identified as identical, modified （decreased or delayed）, and terminated. The results showed that a total of 166 patients were involved. The mean age was 73.28 years old （range, 65-94 years）. There were 143 patients （86.1%, 143/166） assessed with Eastern Cooperative Oncology Group PS ≤2, 72.9% （121/166） with more than one co-morbidity, and47.6% （79/166） with more than two co-morbidities. For final treatment, 74.7% （124/166） patients were identical, while 6.6% （11/166） ones were modified among the 11 patients, 81.8% （9/11） with PS ≤ 2; and 18.7% （31/166） ones were terminated among the 31 patients, 70.9% （22/31） patients with PS ≤ 2. In the groups of modified and terminated treatment, 36 patients had more than one co-morbidity, while there was significant differences compared with the identical group （85.7% vs. 68.5%, P〈0.05）. In conclusion, results confirmed that PS as a primary index of therapeutic decision-making for elderly cancer patients can not reflect the comprehensive status of geriatric cancer patients. Particularly, it could not combine the co-morbidity, poly-pharmacy and function; and thereby, planned treatment could not be accomplished. Co-morbidity was one important factor associated with treatment ch

关 键 词：老年肿瘤 临床决策 老年综合评估 体力状况评分 

分 类 号：R49[医药卫生—康复医学]