| BackgroundCancers are diseases closely related with age, and age is a key factor for consideration in the treatment of cancer from onset to treatment decision. Compared with younger patients, treatment of cancer in patients aged 65 years or older may be threatened with more noticeable limitations and adverse effects, so the risk of death is much higher. Elderly cancer patients enrolled in the most of the current international clinical trials are generally low, therefore unable to provide reliable evidences of evidence-based medicine. And data from the few existing researches have confirmed that age is a high risk factor for the toxicity of chemotherapy in the case of the same benefits in chemotherapy for both elderly tumor patients and younger patients. Taking into account the tolerance to chemotherapy, compared with younger patients, elderly patients have relatively fewer options of chemotherapy, with much lower chemotherapy intensity. It becomes one of the hotspots in the treatment of elderly patients with cancer to make reasonable and effective assessment of the functional status of elderly patients to provide strong supports for the prediction of adverse reactions of chemotherapies and to develop safe and effective chemotherapy plans.The comprehensive geriatric assessment (CGA) described in this paper is a diagnosis process of comprehensive characterization.and analysis of the physiological function and pathological state of the elderly patients in medical, psychological, and functional aspects and in multi-dimensions. Accordingly, treatments to maintain or improve physiological function of patients is proposed to provide accurate and objective judgment basis for the chemotherapy strategies for elderly tumor patients, and therefore to maximize or maintain their quality of life. This study was designed to conduct a series of functional status evaluation mentioned above in elderly patients with cancer, and to discuss whether the CGA system can more accurately reflect the overall functional status and tolerance of related chemotherapy drugs in elderly patients compared with the traditional KPS score.Subjects and methodsOne hundred and fifty three elderly patients hospitalized in the Department of Tumor-chemotherapy of Qianfoshan Hospital, Shandong province were collected from Jan.2014 to Dec.2015, in which 66 who met the inclusion criteria were selected as the research subjects, and all their tumors were confirmed as malignant by pathological diagnosis. All enrolled patients met the following inclusion criteria:(1) age of 65-90 years old; (2) hospital stay of more than 48 hours; (3) clear consciousness; (4) informed and consented to participate in this clinical study; (5) with hematopoietic system malignant tumor, sensitive to chemotherapy, can be completely controlled or even cured by chemotherapy, such as malignant lymphoma; (6) some solid tumors, germ cell tumor, and ovarian cancer that with good therapeutic effect of chemotherapy; (7) postoperative or preoperative adjuvant chemotherapy adjuvant chemotherapy of the surgical resection of solid tumors; (8) solid tumors with extensive or distant metastasis that cannot be surgically resected and treated by radiotherapy.Exclusion criteria were:(1) patients with expected survival time of<3 months; (2) patients in poor general condition, frail, and unable to tolerate chemotherapy; (3) patients with serious dementia, or delirium, or unable to communicate in normal language; (4) severe senile dementia patients with obvious pleural effusion, or various acute and chronic infectious diseases; (5) patients with various acute or chronic infectious disease; (6)patients with severe liver or kidney dysfunctions and electrolyte disturbance; (7)patients with severe cardiovascular and pulmonary dysfunction; (8) patients with poor bone marrow function, severe anemia, and white blood cells and platelets below normal range.Clinical data of patients were recorded and the related comprehensive geriatric assessments was conducted before chemotherapy, including the Eastern Cooperative Oncology Group Performance Status(ECOG), Instrumental Activity of Daily Living assessment (IADL), the Cumulative Illness Rating Scale-Geriatric (CIRS-G), the Mini-Mental State Examination (MMS), the Mini-Nutritional Assessment (MNA), andthe Chemotherapy Risk Assessment Scale for High-age patients (CRASH). Laboratory tests such as routine blood test, and liver and kidney function test as well as regular imaging were conducted to evaluate the clinical efficacy during chemotherapy; adverse events were carefully monitored and recorded during chemotherapy, and patients of the experimental group were given appropriate treatments to prevent side effects based on the evaluation results. Efficacy was evaluated at the end of chemotherapy, and a database was established for all the research data using Excel 2013 and statistical analysis was conducted using the SPSS 19.0 statistical software.ResultsThe 51 patients with a mean age 71.0 years old (range from 65 to 84)consisted of patients with lung cancer (25.5%),gastric cancer (13.7%), intestine cancers (9.8%) esophagus cancer (5.9%), breast cancer (7.8%), ovarian cancer (9.8%), endometrial cancer (5.9%), and others(21.6%).(1) The correlation coefficient of Pearson was 0.237 with P value over 0.05 (0.093), indicating that no correlation was found between age and CRASH.(2) There was significant difference between CRASH and side effect (P=0.010), which was not found between KPS and side effect (P=0.096).(3) The values of side effect and CRASH distributed normally in the histogram.ConclusionIndividualized treatment of elderly cancer patients guided by CGA may accurately predict the potential chemotherapy risk of these patients, so that elderly patients should take measures in advance and benefit from chemotherapy more significantly. |
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