Palliative Radiation Therapy in Older Adults With Cancer: Age-Related Considerations

被引:19
作者
O'Donovan, A. [1 ]
Morris, L. [2 ]
机构
[1] Trinity Coll Dublin, Sch Med, Discipline Radiat Therapy, Appl Radiat Therapy Trinity ARTT Res Grp, Dublin, Ireland
[2] St George Hosp, Dept Radiat Oncol, Sydney, NSW 2217, Australia
关键词
Ageing; cancer; Comprehensive Geriatric Assessment; frailty; palliative radiotherapy; screening; COMPREHENSIVE GERIATRIC ASSESSMENT; OF-LIFE CARE; ELDERLY-PATIENTS; PROSTATE-CANCER; SOCIAL SUPPORT; INSTRUMENTAL ACTIVITIES; METASTATIC CANCER; RISK-FACTORS; FRAILTY; RADIOTHERAPY;
D O I
10.1016/j.clon.2020.06.011
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd.
引用
收藏
页码:766 / 774
页数:9
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