Abstract：
BACKGROUND: The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management for older patients. This study aimed to assess the benefits of the implementation of such a program at a community-based academic cancer center.
METHODS: We analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between 2017 and 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/or hospice care.
RESULTS: The study cohort consisted of 233 patients, of which 76 (32.6%) received SOC, 43 (18.5%) were optimized, and 114 (49.0%) received supportive care or hospice referral. Among the optimized patients, 69.8% were deemed fit for SOC upon re-evaluation following their respective optimization services. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n = 90). Patients receiving supportive/hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p ≤0.001). Patients receiving SOC had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p ≤0.001). For all patients that underwent surgical interventions post-operatively, 23 patients (85%) were discharged home and four (15%) were discharged to a rehabilitation facility.
CONCLUSIONS: The present study demonstrates the profound impact that the complexities in health status and frailty among older individuals can have during cancer management. The Geriatric Oncology Program at BWMC maximized treatment outcomes for older adults through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.
METHODS: We analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between 2017 and 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/or hospice care.
RESULTS: The study cohort consisted of 233 patients, of which 76 (32.6%) received SOC, 43 (18.5%) were optimized, and 114 (49.0%) received supportive care or hospice referral. Among the optimized patients, 69.8% were deemed fit for SOC upon re-evaluation following their respective optimization services. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n = 90). Patients receiving supportive/hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p ≤0.001). Patients receiving SOC had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p ≤0.001). For all patients that underwent surgical interventions post-operatively, 23 patients (85%) were discharged home and four (15%) were discharged to a rehabilitation facility.
CONCLUSIONS: The present study demonstrates the profound impact that the complexities in health status and frailty among older individuals can have during cancer management. The Geriatric Oncology Program at BWMC maximized treatment outcomes for older adults through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.
摘要：
背景：老年患者健康和功能能力的异质性使得癌症的治疗成为一个独特的挑战。马里兰大学巴尔的摩华盛顿医学中心（BWMC）的老年肿瘤学计划旨在优化老年患者的癌症管理。这项研究旨在评估在基于社区的学术癌症中心实施此类计划的好处。
方法：我们分析了2017年至2022年间接受老年肿瘤学项目的≥80岁患者。一个多学科专家团队使用老年病学特定领域对每位患者进行了集体审查，并将每位患者分为三个管理组之一：第1组：被认为适合接受标准肿瘤护理（SOC）的患者；第2组：建议在重新评估SOC之前接受优化服务的患者；第3组：被认为最适合支持护理和/或临终关怀护理的患者。
结果：研究队列包括233名患者，其中76人(32.6%)获得SOC，43（18.5%）进行了优化，114人(49.0%)接受支持治疗或临终关怀转诊。在优化的患者中，根据各自的优化服务，在重新评估后，69.8%被认为适合SOC。加拿大健康与衰老-临床虚弱量表研究（CSHA-CFS）评分于2019年实施（n=90）。接受支持/临终关怀护理的患者平均得分为5.8，而优化组和SOC组的平均得分为4.6和4.1（p≤0.001）。与优化组（2.30年）和支持治疗组（0.93年）相比，接受SOC的患者的平均生存期最长为2.71年（p≤0.001）。对于所有术后接受手术干预的患者，23名患者（85％）出院回家，4名（15％）出院到康复机构。
结论：本研究表明，在癌症治疗过程中，老年人健康状况和虚弱的复杂性会产生深远的影响。BWMC的老年肿瘤学计划通过提供SOC治疗和优化服务，最大限度地提高了老年人的治疗效果。同时也在以患者为中心的层面上减少不必要的干预。
方法：我们分析了2017年至2022年间接受老年肿瘤学项目的≥80岁患者。一个多学科专家团队使用老年病学特定领域对每位患者进行了集体审查，并将每位患者分为三个管理组之一：第1组：被认为适合接受标准肿瘤护理（SOC）的患者；第2组：建议在重新评估SOC之前接受优化服务的患者；第3组：被认为最适合支持护理和/或临终关怀护理的患者。
结果：研究队列包括233名患者，其中76人(32.6%)获得SOC，43（18.5%）进行了优化，114人(49.0%)接受支持治疗或临终关怀转诊。在优化的患者中，根据各自的优化服务，在重新评估后，69.8%被认为适合SOC。加拿大健康与衰老-临床虚弱量表研究（CSHA-CFS）评分于2019年实施（n=90）。接受支持/临终关怀护理的患者平均得分为5.8，而优化组和SOC组的平均得分为4.6和4.1（p≤0.001）。与优化组（2.30年）和支持治疗组（0.93年）相比，接受SOC的患者的平均生存期最长为2.71年（p≤0.001）。对于所有术后接受手术干预的患者，23名患者（85％）出院回家，4名（15％）出院到康复机构。
结论：本研究表明，在癌症治疗过程中，老年人健康状况和虚弱的复杂性会产生深远的影响。BWMC的老年肿瘤学计划通过提供SOC治疗和优化服务，最大限度地提高了老年人的治疗效果。同时也在以患者为中心的层面上减少不必要的干预。
