四川7家医院住院老年肿瘤患者综合评估结果分析

Analysis of comprehensive assessment results of the elderly hospitalized cancer patients

摘要:

目的 分析四川7家医院住院老年肿瘤患者综合评估结果及预后。方法 2012年7月到2014年1月间对四川省7家医院488例年龄≥65岁的住院老年肿瘤(肺癌、前列腺癌、结直肠癌和恶性淋巴瘤)患者进行综合评估,分析老年综合征情况并比较不同功能组患者随访1年的预后情况。应用SPSS 22.0统计软件对数据进行分析。组间比较用χ²检验。结果 488例患者中严重合并症占76.4%(373/488),工具性日常生活能力(IADL)受损占68.6%(335/488),视力障碍占68.2%(333/488),跌倒高危人群占51.0%(249/488),社会支持不足占10.0%(49/488)。65～75岁组患者营养不良风险和营养不良患者比例高于76～85岁和＞85岁组患者,差异有统计学意义(P＜0.001)。37.5%(183/488)的老年肿瘤患者随访期内发生肿瘤恶化进展/复发,功能障碍组患者恶化进展/复发率(41.5%,92/222)高于功能独立组(16.7%,4/24)和失能组(36.0%,87/242),差异具有统计学意义(P＜0.05)。患者的1年死亡率为11.9%(58/488),功能独立组无死亡,失能组死亡率(21.1%,51/242)高于功能障碍组(3.4%,7/222),差异具有统计学意义(P＜0.001)。接受化疗的273例患者中76.9%(210/273)未完成预计治疗疗程,失能组未完成预计治疗疗程的比例为100.0%(96/96),高于功能障碍组(67.1%,110/164)和功能独立组(30.8%,4/13),差异具有统计学意义(P＜0.001)；79.9%(218/273)的患者发生不同程度的放/化疗副反应,其中≥3级副反应率为19.0%(52/273),不同功能组间的副反应发生率差异无统计学意义(P=0.108)。结论 老年综合征在住院老年肿瘤人群中普遍存在,其中合并症和IADL受损最常见,部分功能障碍患者易发生肿瘤恶化进展/复发,失能患者未完成预计治疗疗程的比例和1年死亡率高。

Abstract:

Objective To investigate the findings in the assessment and prognosis of the elderly cancer patients with comprehensive geriatric assessment (CGA) in 7 hospitals in Sichuan Province. Methods CGA was made for 488 elderly cancer patients (lung cancer, prostate cancer, colorectal cancer and malignant lymphoma) aged 65 years or over, who were treated in 7 hospitals in Sichuan Province from July 2012 to January 2014. An analysis was made of their geriatric syndrome, and a comparison was made of the prognosis between groups with different functional levels within 1-year follow-up. SPSS statistics 22.0 was used for data analysis, and Chi-square test for comparison groups. Results Severe complications were seen in 76.4%(373/488), impaired instrumental activities of daily living (IADL) in 68.6%(335/488), visual impairment in 68.2%(333/488), high risk for falling in 51.0%(249/488), and social support deficiency in 10.0%(49/488). Age group 65-75 years had higher risk and higher proportion of malnutrition than age groups of 76-85 and of >85 years, the difference being statistically significant (P<0.001). Progression or recurrence of cancer was observed in 37.5%(183/488) during the follow-up period. The rate of progression/recurrence was 41.5%(92/222) in dysfunctional group, 16.7%(4/24) in functionally independent group, and 36.0%(87/242) in disability group, the difference being statistically significant (P<0.05). The 1-year mortality rate was 11.9%(58/488) with no death in the functionally independent group. The mortality rate in the disability group was 21.1%(51/242), which was significantly higher than that in the dysfunctional group 3.4%(7/222) (P<0.001). Of 273 patients who received chemotherapy, 76.9%(210/273) did not complete the expected course of treatment. In the disability group, 100.0%(96/96) did not complete the expected course of treatment, which was higher than 67.1%(110/164) in the dysfunctional group and 30.8%(4/13) in the functionally independent group, the difference being statistically significant (P<0.001). Side effects of radio/chemotherapy were seen in 79.9%(218/273), of which 19.0%(52/273) were Grade 3 or above. There was no statistically significant difference in the incidence of side effects between groups (P=0.108). Conclusion Geriatric syndrome is common in hospitalized elderly tumor population, in which complications and IADL are the most common, and some dysfunctional patients are prone to tumor progression/recurrence. The proportion of those who did not complete the expected course of treatment and 1-year mortality were high in the disabled patients.