Sharon He, Heather L. Shepherd, Meera Agar, Joanne Shaw
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引用次数: 0
Abstract
Background: Geriatric assessments (GAs) can guide treatment decision-making for older adults with cancer and identify those at risk of treatment complications. Given the number of systematic reviews conducted in the last 10 years, this umbrella review aimed to summarise and synthesise the evidence for (i) what constitutes a GA in cancer care, (ii) how GAs are conducted, and (iii) how implementation of GAs in cancer settings are reported.
Methods: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Library and Web of Science databases were searched and updated in September 2024. Systematic reviews with or without meta-analyses that (i) described the use or value of GA for older adults with cancer, or (ii) information related to GA implementation in cancer settings were included in this review. Quality of the reviews were assessed using the AMSTAR-2 tool, and results were descriptively summarised using a narrative synthesis.
Results: Twenty-nine reviews were included. A GA was commonly defined as a systematic, multidimensional evaluation of an older person. Recommendation for domains included within the GA differed across reviews. However, commonly reported domains and tools across reviews broadly mapped to the National Comprehensive Cancer Network guideline recommendations. Fifteen reviews specified timing of GA; most reported assessments were performed prior to treatment and administered by a range of individuals including patient themselves, the multi-disciplinary team, individual nurse or cancer specialists or geriatrician-led consultation or assessments. Barriers and enablers to GA implementation were discussed in three reviews. Four reviews described GA feasibility, primarily reporting patient acceptability of self-administered or computer-based assessments.
Discussion: Heterogeneity across reviews in GA definition could impact on perceived feasibility of GA implementation. Standardisation of GA domains is required to facilitate evidence-based research and to guide integration of GA and GA-based interventions within cancer settings.
背景：老年评估（GAs）可以指导老年癌症患者的治疗决策，并识别治疗并发症的风险。鉴于过去10年进行的系统评价的数量，本综述旨在总结和综合以下方面的证据：(i)癌症护理中GA的构成，（ii）如何进行GAs，以及（iii）如何报告癌症环境中GAs的实施。方法：检索并更新2024年9月的PsycINFO、MEDLINE、EMBASE、CINAHL、Cochrane Library和Web of Science数据库。有或没有荟萃分析的系统评价(i)描述了GA对老年癌症患者的使用或价值，或（ii）癌症环境中GA实施的相关信息被纳入本综述。使用AMSTAR-2工具评估评价的质量，并使用叙述性综合对结果进行描述性总结。结果：纳入29篇综述。GA通常被定义为对老年人进行系统的、多维的评估。对GA中包含的域的建议因审查而异。然而，通常报道的领域和工具在审查中广泛映射到国家综合癌症网络指南建议。十五次评审指定GA时间；大多数报告的评估是在治疗前进行的，并由一系列个人进行管理，包括患者本人、多学科团队、个别护士或癌症专家或老年医生主导的咨询或评估。在三篇综述中讨论了遗传算法实现的障碍和推动因素。四篇综述描述了GA的可行性，主要报告了患者对自我管理或基于计算机的评估的接受程度。讨论：遗传算法定义的异质性可能会影响遗传算法实现的可行性。需要对遗传域进行标准化，以促进基于证据的研究，并指导在癌症环境中整合遗传和基于遗传的干预措施。
期刊介绍：
The European Journal of Cancer Care aims to encourage comprehensive, multiprofessional cancer care across Europe and internationally. It publishes original research reports, literature reviews, guest editorials, letters to the Editor and special features on current issues affecting the care of cancer patients. The Editor welcomes contributions which result from team working or collaboration between different health and social care providers, service users, patient groups and the voluntary sector in the areas of:
- Primary, secondary and tertiary care for cancer patients
- Multidisciplinary and service-user involvement in cancer care
- Rehabilitation, supportive, palliative and end of life care for cancer patients
- Policy, service development and healthcare evaluation in cancer care
- Psychosocial interventions for patients and family members
- International perspectives on cancer care
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