Zusammenfassung
Hintergrund
Inwieweit eine multidimensionale geriatrische Evaluation mit eng daran gekoppelter multimodaler geriatrischer Intervention sich bei alten Tumorpatienten dazu eignet, deren Vulnerabilität und Risiko für Komplikationen einschließlich exazerbierter Frailty günstig zu beeinflussen, ist angesichts fundamentaler altersdemografischer Veränderungen und dem sich damit wandelnden onkologischen Patientengut eine immer bedeutsamere Fragestellung.
Ziel
Die aktuelle Evidenz sowie die gegenwärtigen Forschungsaktivitäten und Versorgungsstrukturen sollen zusammengestellt werden.
Methoden
Es wurde eine Literaturrecherche in PubMed und von Kongressabstracts durchgeführt.
Ergebnisse
In ersten, noch kleinen Vergleichsstudien wurde der Nutzen onkogeriatrischer Interventionen als Supportiv- bzw. Präventivmaßnahme bei chemotherapeutischer bzw. tumorchirurgischer Behandlung untersucht. Die Ergebnisse waren gemischt. Große multizentrische, randomisiert-kontrollierte Studien wurden begonnen, aber Resultate sind noch nicht verfügbar. Modelle zur Implementierung onkogeriatrischer Interventionskonzepte in die Versorgungspraxis sind vielfältig, aber bislang kaum verwirklicht.
Schlussfolgerungen
Onkogeriatrische Interventionen können die onkologische Versorgung alter Tumorpatienten potenziell verbessern. Die breite Implementierung in die Routineversorgung hängt jedoch von den Ergebnissen laufender prospektiver Studien sowie Kooperationsinitiativen zwischen onkologischen und geriatrischen Versorgern ab.
Abstract
Background
In view of fundamental age demographic alterations and the changing composition of patient populations in oncological care, there is a need to clarify whether a multidimensional geriatric assessment with a closely linked multimodal geriatric intervention in older cancer patients will enable their vulnerability and risk of complications, including exacerbated frailty to be positively influenced.
Objective
Review of available evidence, current research activities and proposed models of care.
Methods
Literature search in PubMed and congress abstracts.
Results
Initial comparative studies of limited size have studied the benefits of oncogeriatric interventions as supportive or preventive measures in the context of chemotherapy or surgical treatment of tumors. The results were mixed. Large multicentric randomized controlled trials have been initiated but the results are not yet available. Many models for implementing oncogeriatric intervention concepts in routine practice have been proposed but have so far barely been realized.
Conclusion
Oncogeriatric interventions have the potential to improve oncological care in older cancer patients; however, their broad implementation in routine practice requires further evidence to be generated by currently ongoing prospective trials as well as cooperative initiatives between oncological and geriatric healthcare providers.
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V. Goede hat Referenten- und/oder Beraterhonorare und/oder Studienunterstützung von F. Hoffmann-La Roche, Janssen, Gilead, Abbvie, Glaxo Smith Kline, Mundipharma, Bristol Myers Squibb erhalten. U. Wedding gibt an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Goede, V., Wedding, U. Vom geriatrischen Assessment zur geriatrischen Intervention. Onkologe 25, 776–783 (2019). https://doi.org/10.1007/s00761-019-0573-6
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DOI: https://doi.org/10.1007/s00761-019-0573-6