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.

中文翻译：

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执业临床医生的老年病学评估：原因、内容和方法


患有癌症的老年人在医疗保健、治疗和症状方面的经历各不相同。老年病学评估 （GA） 对老年人的健康状况进行全面评估，可以预测实体瘤和血液系统恶性肿瘤患者的癌症相关结果。在过去十年中，随机对照试验证明了 GA 和 GA 管理 （GAM） 的好处，后者使用 GA 信息提供量身定制的干预策略来解决 GA 损伤（例如，对身体功能受损实施物理治疗）。针对患有实体瘤和血液系统恶性肿瘤的老年人的多项 3 期临床试验表明，GAM 可改善治疗完成度、生活质量、沟通和预先护理计划，同时减少与治疗相关的毒性、跌倒和多药治疗。尽管如此，GAM 的实施和采用仍然具有挑战性。已经提出了各种策略，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健康等技术以提高 GA 和 GAM 干预措施的可用性。少数群体的健康不平等现象仍然存在，系统性的 GA 实施有可能捕捉到与公平护理相关的健康社会决定因素。照护者在癌症护理中发挥着重要作用，他们自己也承受着负担。GA 可以指导二元支持性护理干预，最终帮助患者和护理人员实现最佳健康。