背景:在癌症治疗中,治疗期间的症状监测可改善临床结果,例如提高生活质量,更长的生存时间,住院人数减少。然而,由于大多数癌症患者年龄较大,并且患有多种疾病,他们可能受益于监测其他症状。这项研究的目的是确定一组核心症状,以监测老年患者的多种疾病治疗癌症,包括治疗副作用引起的症状,合并症的不稳定,功能下降。
方法:在范围文献检索中,使用17份生活质量问卷选择53种可能的症状进行监测。一个由癌症和老年医学专家组成的专家小组被要求参加多个在线调查,以表明这些症状是否与监测无关,仅与特定患者组中的监测相关,或相关的监测所有患者。在随后的一轮中,列表被减少,并且小组指示在癌症治疗期间和癌症治疗完成之后应当监测这些症状的频率。最后,组织了一次数字共识会议,以决定何时症状必须触发建议患者与他们的医疗团队联系。
结果:总计,30名医疗保健专业人员参加了在线调查。两轮过后,与癌症相关的19种症状的数据集,癌症治疗,功能衰退,并同意对合并症进行不稳定监测。在治疗期间选择5种症状进行日常监测,每周七个,每月七个。治疗完成后,小组同意减少报告的频率。此外,选择了仅在具有特定癌症类型或治疗类型的患者中监测的9种症状,比如肺癌中的“咳血”。
结论:这项研究首次确定了一组核心症状,以监测老年多重性癌症患者。需要进一步的研究来调查这些症状的监测是否可行,并改善老年患者的临床预后。
In cancer care, symptom monitoring during treatment results in improved clinical outcomes such as improved quality of life, longer survival, and fewer hospital admissions. However, as the majority of patients with cancer are older and have multimorbidity, they may benefit from monitoring of additional symptoms. The aim of this study was to identify a core set of symptoms to monitor in older patients with multimorbidity treated for cancer, including symptoms caused by treatment side effects, destabilization of comorbidities, and functional decline.
During a scoping literature search, 17 quality of life questionnaires were used to select 53 possible symptoms to monitor. An expert panel of cancer and geriatrics specialists was asked to participate in multiple online surveys to indicate whether these symptoms were not relevant to monitor, only relevant to monitor in a specific patient group, or relevant to monitor in all patients. In a subsequent round the list was reduced and the panel indicated how frequently these symptoms should be monitored during cancer treatment and after cancer treatment completion. Finally, a digital
consensus meeting was organised to decide when symptoms had to trigger a recommendation to the patient to get in touch with their medical team.
In total, 30 healthcare professionals participated in the online surveys. After two rounds, a dataset of 19 symptoms related to cancer, cancer treatment, functional decline, and destabilization of comorbidities was agreed upon for monitoring. Five symptoms were selected for daily monitoring during treatment, seven for weekly, and seven for monthly. After treatment completion, the panel agreed upon less frequent reporting. Additionally, nine symptoms to be monitored only in patients with specific cancer types or treatment types were chosen, such as \"cough up blood\" in lung cancer.
This study is the first to identify a core set of symptoms to monitor in older patients with multimorbidity treated for cancer. Future research is needed to investigate whether the monitoring of these symptoms is feasible and improves clinical outcomes in older patients with multimorbidity treated for cancer.