研究动态
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执业临床医生的老年评估:原因、内容和方式。

Geriatric assessment for the practicing clinician: The why, what, and how.

发表日期:2024 Aug 29
作者: Allison Magnuson, Kah Poh Loh, Fiona Stauffer, William Dale, Nikesha Gilmore, Sindhuja Kadambi, Heidi D Klepin, Kaitlin Kyi, Lisa M Lowenstein, Tanyanika Phillips, Erika Ramsdale, Melody K Schiaffino, John F Simmons, Grant R Williams, Jason Zittel, Supriya Mohile
来源: CA-A CANCER JOURNAL FOR CLINICIANS

摘要:

患有癌症的老年人经历的医疗保健、治疗和症状各不相同。老年评估 (GA) 可以对老年人的健康状况进行全面评估,并可以预测实体瘤和血液恶性肿瘤患者的癌症相关结果。在过去的十年中,随机对照试验已经证明了 GA 和 GA 管理 (GAM) 的好处,GAM 使用 GA 信息提供量身定制的干预策略来解决 GA 损伤(例如,针对受损的身体功能实施物理治疗)。针对患有实体瘤和血液恶性肿瘤的老年人的多项 3 期临床试验表明,GAM 可以改善治疗完成度、生活质量、沟通和预先护理计划,同时减少治疗相关的毒性、跌倒和多重用药。尽管如此,GAM 的实施和采用仍然具有挑战性。人们提出了各种策略,包括使用 GA 筛查工具来识别最有可能从 GAM 中受益的患者、肿瘤学工作人员系统地参与 GAM 的提供,以及整合远程医疗和移动医疗等技术以增强治疗效果GA 和 GAM 干预措施的可用性。少数群体的健康不平等现象依然存在,系统性的全球治理实施有可能捕捉到与公平医疗相关的健康社会决定因素。护理人员在癌症护理中发挥着重要作用,但他们自己也承受着负担。 GA 可以指导二元支持性护理干预措施,最终帮助患者和护理人员实现最佳健康。© 2024 作者。 CA:Wiley periodicals LLC 代表美国癌症协会出版的《临床医生癌症杂志》。
Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.© 2024 The Author(s). CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society.