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目的:本研究通过对老年肿瘤住院患者进行回顾性分析,详细记录患者治疗计划和实际接受治疗的符合情况,并分析其改变治疗计划的原因,讨论单纯以体力状况评分(Performance Status,PS)作为患者治疗决策主要制定依据存在的问题及开展老年综合评估(Comprehensive Geriatric Assessment,CGA)的必要性。方法:纳入2009年9月-2011年8月期间于北京大学肿瘤医院中西医结合暨老年肿瘤科病区,65岁以上的老年肿瘤住院患者,根据其病例记录,设计临床研究(Clinical Research Forms,CRF)表格。记录入组患者住院期间主要依据体力状况PS评分所制定的相应治疗计划(标准治疗、个体化治疗/减量化疗或口服靶向药物治疗、最佳支持治疗)以及患者最终完成的治疗方案,将其结果分为3类:①按计划实施;②不能按照原计划实施,需调整治疗方案,即减量化疗或更改为口服靶向药物等;③不能按计划接受治疗或终止治疗。结果:166例老年肿瘤住院患者纳入本项研究。年龄65-94岁,平均年龄73.28岁。PS≤2分者143例(占86.1%,143/166),给予常规化疗或靶向治疗或单纯中药治疗;PS=3-4分者23例(占13.9%,23/166)给予最佳支持治疗。治疗计划与实际治疗相吻合者占74.7%(124/166);在不能按照计划给予治疗的42例患者中,需调整(减量化疗或更改为口服靶向药物等)治疗方案者11例,其中,PS评分≤2者9例;不能耐受治疗或终止治疗者31例,其中,PS评分≤2者22例。在这42例患者中,36例(占85.7%,36/42)具有一种以上的内科基础病,25例(占59.5%,25/42)具有两种或两种以上的内科基础病;在吻合原方案治疗组中,85例患者具有一种以上内科基础病(占68.5%,85/124),两组进行合并症数量的比较,差异具有显著统计学意义(P<0.05)。结论:以单纯PS评分结果作为老年肿瘤患者诊疗方案制定的主要依据不能全面体现老年肿瘤患者的综合情况,从而在一定程度上导致治疗方案不能按计划进行;内科合并症的数量是导致治疗不能按计划进行的原因之一。
OBJECTIVE: In this study, retrospective analysis of hospitalized patients with senile cancer was carried out. The patient’s treatment plan and actual acceptance were recorded in detail. The reasons for the change in treatment plan were analyzed. Performance status (PS) Patient treatment decisions are mainly based on existing problems and the need for a Comprehensive Geriatric Assessment (CGA). Methods: A retrospective study was conducted from September 2009 to August 2011 in the hospital of Integrative Medicine and Geriatric Oncology in Peking University Tumor Hospital. Patients aged 65 years and over were enrolled in this study. Clinical Research Forms CRF) form. The corresponding treatment plan (standard treatment, individualized treatment / reduced-dose chemotherapy or oral targeted drug therapy, optimal supportive treatment) and the final treatment plan completed by the patients mainly based on the physical status PS score during the hospitalization were recorded. The results are divided into three categories: ① according to the plan; ② can not be implemented as originally planned, need to adjust the treatment plan, that is, reduced chemotherapy or changed to oral targeted drugs; ③ can not be treated as scheduled or termination of treatment. Results: 166 elderly patients with oncology were included in this study. Age 65-94 years old, with an average age of 73.28 years old. 143 cases (86.1%, 143/166) with PS≤2 points were given conventional chemotherapy or targeted therapy or simple Chinese medicine treatment; 23 cases (13.9%, 23/166) with PS = 3-4 were given the best Support treatment. Among the 42 patients who could not be treated according to the plan, 11 patients were required to adjust the treatment regimen (such as reducing chemotherapy or changing to oral targeted drug) Among them, PS score ≤ 2 in 9 cases; can not tolerate treatment or termination of treatment in 31 cases, of which PS score ≤ 2 in 22 cases. Among these 42 patients, 36 (85.7%, 36/42) had more than one medical basis disease and 25 (59.5%, 25/42) had two or more medical underlying diseases. 85 patients had more than one kind of medical basic disease (68.5%, 85/124) in the treatment group of anastomotic protocol. There was significant difference between the two groups in the number of complications (P <0.05). Conclusion: PS score alone as the main basis for the development of diagnosis and treatment of elderly patients with cancer can not fully reflect the comprehensive situation of elderly patients with cancer, which to some extent led to the treatment plan can not be carried out as planned; the number of medical complications is leading to treatment can not press One of the reasons why the plan is going.