geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-2-2023-86-91geriatr-355Research ArticleГЛАВНАЯ ТЕМАMAIN TOPICНа стыке гериатрии и онкологии: состояние проблемыAt the turn of geriatrics and oncology: state of the problemhttps://orcid.org/0000-0003-1222-3351ОстапенкоВ. С.OstapenkoV. S.

Остапенко Валентина Сергеевна, канд. мед. наук, врач-гериатр, заведующая отделением гериатрической терапии, доцент кафедры болезней старения

телефон: +7(916)244-59-24

Москва

Ostapenko Valentina S., MD, PhD, Head of Geriatrics Department, Associate Professor, Age-Related Diseases Department

Moscow

ostapenkovalent@yandex.ruАбсалямовР. И.AbsalyamovR. I.

Абсалямов Руслан Ильдарович, врач-онколог, химиотерапевт, хирург, руководитель онкологического направления

телефон: +7(926)591-73-23

Москва

Absalyamov Ruslan I., oncologist, chemotherapist, surgeon, Head of the Oncological Department

Moscow

absalyamov@klinikarassvet.ruФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России, Российский геронтологический научно-клинический центрРоссияRussian Gerontology Research and Clinical Centre, Pirogov National Research Medical UniversityRussian FederationКлиника «Рассвет»РоссияRassvet ClinicRussian Federation202319072023028691Copyright © Остапенко В.С., Абсалямов Р.И., 20232023Остапенко В.С., Абсалямов Р.И.Ostapenko V.S., Absalyamov R.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/355

Несмотря на рост числа пациентов пожилого и старческого возраста со злокачественными новообразованиями, тактика их ведения зачастую является неоптимальной, а модель взаимоотношений между врачом и пациентом — патерналистской.

Отсутствие достаточных знаний в области гериатрической помощи среди медицинских работников, занимающихся лечением пациентов с онкологическими заболеваниями, и низкая представленность пациентов старческого возраста в исследованиях приводят к уязвимости этих пациентов как для «чрезмерного», так и для «недостаточного» лечения. Накоплено достаточно данных, свидетельствующих о превосходстве комплексной гериатрической оценки в выявлении ослабленных пациентов с риском неблагоприятных исходов в сравнении с обычной клинической оценкой или традиционными инструментами, используемыми в онкологии. Планирование терапии с учетом гериатрического статуса и предпочтений пациента позволяет добиться лучших результатов и удовлетворенности пациентов с онкологическими заболеваниями.

Despite the increase in the number of older and oldest old patients with cancer, the tactics of their treatment are often suboptimal while the doctor-patient relationship model tends to be paternalistic.

Insufficient knowledge in the field of geriatric care among health care providers dealing with cancer patients along with the low representation of older patients in research lead to their vulnerability to both «over- and under-treatment». There is ample evidence to support the superiority of comprehensive geriatric assessment in identifying frail patients at risk of poor outcomes compared to conventional clinical assessment or traditional oncology tools. Planning therapy taking into account the geriatric status and preferences of the patient, allows us to add the best results and satisfaction of aging patients with oncological diseases.

гериатрияонкологияонкогериатриязлокачественные новообразованияонкологические заболеванияпожилой и старческий возрасткомплексная гериатрическая оценкагериатрические синдромыстарческая астенияхимиотерапиялучевая терапияуходgeriatricsoncologyoncogeriatricscanceroncological diseasesolder and oldest oldcomprehensive geriatric assessmentgeriatric syndromesfrailtychemotherapyradiation therapycareReferencesMarosi C., Köller M. Challenge of cancer in the elderly. ESMO Open. 2016; 1(3).Marosi C., Köller M. Challenge of  cancer in  the elderly. ESMO Open. 2016; 1(3).Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. Состояние онкологической помощи населению России в 2021 году. — М.: МНИОИ им. П.А. Герцена — филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2020. — илл. — 239 с. ISBN 978-5-85502-255-1Kaprin A.D., Starinsky  V.V., Shakhzadova A.O. The state of oncological care for the population of  Russia in  2021.  — M.: MNIOI P.A. Herzen  — branch of  the Federal State Budgetary Institution "NMITs Radiology" of  the Ministry of  Health of  Russia, 2020.  — ill.  — 239 p. ISBN 978-5-85502-255-1Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, D.C.: The National Academies Press, 2013.Institute of Medicine. Delivering High-Quality Cancer Care: Charting a  New Course for a  System in  Crisis. Washington, D.C.: The National Academies Press, 2013.Mizutani T. Practical management of older adults with cancer: geriatric oncology in Japan. Jpn J Clin Oncol. 2022 Oct 6; 52(10): 1073–1081. DOI: 10.1093/jjco/hyac118. PMID: 35863011; PMCID: PMC9538777.Mizutani T. Practical management of  older adults with cancer: geriatric oncology in Japan. Jpn J Clin Oncol. 2022 Oct 6; 52(10): 1073–1081. DOI: 10.1093/jjco/hyac118. PMID: 35863011; PMCID: PMC9538777.Прощаев К.И., Ткаченко Е.В., Коневалова Н.Ю. и др. Изучение уровня знаний специалистов онкологической службы, принимающих участие в оказании гериатрической помощи пациентам Медицинское образование XXI века: компетентностный подход и его реализация в системе непрерывного медицинского и фармацевтического образования. Сборник материалов Республиканской научно-практической конференции с международным участием. Витебский государственный медицинский университет. 2017, С. 116–121Proschaev K.I., Tkachenko E.V., Konevalova N.Y. Studying the level of knowledge of oncology specialists involved in providing geriatric care to patients Medical education of  the 21st century: a  competency-based approach and its implementation in  the system of  continuous medical and pharmaceutical education. Collection of materials of the Republican scientific-practical conference with international participation. Vitebsk State Medical University. 2017, P. 116–121Hurria A., Dale W., Mooney M., et al. Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 32: 2587–2594, 2014.Hurria A., Dale W., Mooney M., et al. Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 32: 2587–2594, 2014.Shapiro C.L. Cancer Survivorship. N Engl J Med. 2018; 379(25): 2438–2450.Shapiro C.L. Cancer Survivorship. N  Engl J  Med. 2018; 379(25): 2438–2450.Repetto L., Fratino L., Audisio R.A., et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002; 20(2): 494–502.Repetto L., Fratino L., Audisio R.A., et  al. Comprehensive geriatric assessment adds information to  Eastern Cooperative Oncology Group performance status in  elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002; 20(2): 494–502.Kirkhus L., Saltyte Benth J., Rostoft S. et al. Geriatric assessment is superior to oncologists’ clinical judgement in identifying frailty. Br J Cancer. 2017; 117(4): 470–477.Kirkhus L., Saltyte Benth J., Rostoft S. et  al. Geriatric assessment is  superior to  oncologists’ clinical judgement in identifying frailty. Br J Cancer. 2017; 117(4): 470–477.Bruijnen C.P., van Harten-Krouwel D.G., Koldenhof J.J. et al. Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review. J Geriatr Oncol. 2019; 10(6): 859–873.Bruijnen C.P., van Harten-Krouwel D.G., Koldenhof J.J. et al. Predictive value of each geriatric assessment domain for older patients with cancer: A  systematic review. J  Geriatr Oncol. 2019; 10(6): 859–873.Transferability to clinical practice of the results of controlled clinical trials: the case of antiemetic prophylactic treatment for cancer chemotherapy-induced nausea and vomiting. Italian Group for Antiemetic Research. Annals of oncology: official journal of the European Society for Medical Oncology. 1998; 9(7): 759–765.Transferability to clinical practice of the results of controlled clinical trials: the case of  antiemetic prophylactic treatment for cancer chemotherapy-induced nausea and vomiting. Italian Group for Antiemetic Research. Annals of oncology: official journal of the European Society for Medical Oncology. 1998; 9(7): 759–765.Kenis C., Baitar A., Decoster L., et al. The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer. Cancer. 2018; 124(18): 3753–3763.Kenis C., Baitar A., Decoster L., et  al. The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer. Cancer. 2018; 124(18): 3753–3763.Bruijnen C.P., van Harten-Krouwel D.G., Koldenhof J.J. et al. Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review. J Geriatr Oncol. 2019.Bruijnen C.P., van Harten-Krouwel D.G., Koldenhof J.J. et al. Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review. J Geriatr Oncol. 2019.Williams G.R., Dunham L., Chang Y., et al. Geriatric Assessment Predicts Hospitalization Frequency and Long-Term Care Use in Older Adult Cancer Survivors. J Oncol Pract. 2019: JOP1800368.Williams G.R., Dunham L., Chang Y., et  al. Geriatric Assessment Predicts Hospitalization Frequency and Long-Term Care Use in  Older Adult Cancer Survivors. J  Oncol Pract. 2019: JOP1800368.Cohen H.J., Smith D., Sun C.L., et al. Frailty as determined by a comprehensive geriatric assessmentderived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer. 2016; 122(24): 3865–3872.Cohen H.J., Smith D., Sun C.L., et al. Frailty as determined by a comprehensive geriatric assessment- derived deficit-accumulation index in  older patients with cancer who receive chemotherapy. Cancer. 2016; 122(24): 3865–3872.Guerard E.J., Deal A.M., Chang Y., et al. Frailty Index Developed From a Cancer-Specific Geriatric Assessment and the Association With Mortality Among Older Adults With Cancer. J Natl Compr Canc Netw. 2017; 15(7): 894–902.Guerard E.J., Deal A.M., Chang Y., et  al. Frailty Index Developed From a  Cancer-Specific Geriatric Assessment and the Association With Mortality Among Older Adults With Cancer. J Natl Compr Canc Netw. 2017; 15(7): 894–902.Abel G.A., Klepin H.D. Frailty and the management of hematologic malignancies. Blood. 2018; 131(5): 515–524.Abel G.A., Klepin H.D. Frailty and the management of hematologic malignancies. Blood. 2018; 131(5): 515–524.Shahrokni A., Tin A., Alexander K., et al. Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer. JAMA Netw Open. 2019; 2(5): e193545.Shahrokni A., Tin A., Alexander K., et al. Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer. JAMA Netw Open. 2019; 2(5): e193545.Ahmed A., Deng W., Tew W. et al. Pre-operative assessment and post-operative outcomes of elderly women with gynecologic cancers, primary analysis of NRG CC-002: An NRG oncology group/ gynecologic oncology group study. Gynecol Oncol. 2018; 150(2): 300–305.Ahmed A., Deng W., Tew W. et al. Pre-operative assessment and post-operative outcomes of  elderly women with gynecologic cancers, primary analysis of  NRG CC-002: An  NRG oncology group/ gynecologic oncology group study. Gynecol Oncol. 2018; 150(2): 300–305.Hamaker M.E., Te Molder M., Thielen N. et al. The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients — A systematic review. J Geriatr Oncol. 2018; 9(5): 430–440.Hamaker M.E., Te Molder M., Thielen N. et al. The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients — A systematic review. J Geriatr Oncol. 2018; 9(5): 430–440.Corre R., Greillier L., Le Caer H. et al. Use of a Comprehensive Geriatric Assessment for the Management of Elderly Patients With Advanced Non-Small-Cell Lung Cancer: The Phase III Randomized ESOGIA-GFPC-GECP 08–02 Study. J Clin Oncol. 2016; 34(13): 1476–1483.Corre R., Greillier L., Le Caer H. et al. Use of a Comprehensive Geriatric Assessment for the Management of Elderly Patients With Advanced Non-Small-Cell Lung Cancer: The Phase III Randomized ESOGIA-GFPC-GECP 08–02 Study. J  Clin Oncol. 2016; 34(13): 1476–1483.Kalsi T., Babic-Illman G., Ross P.J. et al. The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people. Br J Cancer. 2015; 112(9): 1435–1444.Kalsi T., Babic-Illman G., Ross P.J. et  al. The impact of  comprehensive geriatric assessment interventions on  tolerance to  chemotherapy in  older people. Br  J Cancer. 2015; 112(9): 1435–1444.Mohile S.G., Velarde C., Hurria A. et al. Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts. J Natl Compr Canc Netw. 2015; 13(9): 1120–1130.Mohile S.G., Velarde C., Hurria A. et al. Geriatric Assessment-Guided Care Processes for Older Adults: A  Delphi Consensus of  Geriatric Oncology Experts. J  Natl Compr Canc Netw. 2015; 13(9): 1120–1130.Schulkes K.J.G., Souwer E.T.D., Hamaker M.E., et al. The Effect of A Geriatric Assessment on Treatment Decisions for Patients with Lung Cancer. Lung. 2017; 195(2): 225–231.Schulkes K.J.G., Souwer E.T.D., Hamaker M.E., et  al. The Effect of A Geriatric Assessment on Treatment Decisions for Patients with Lung Cancer. Lung. 2017; 195(2): 225–231.Hamaker M.E., Te Molder M., Thielen N., et al. The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients — A systematic review. J Geriatr Oncol. 2018; 9(5): 430–440.Hamaker M.E., Te Molder M., Thielen N., et al. The effect of  a geriatric evaluation on  treatment decisions and outcome for older cancer patients — A systematic review. J Geriatr Oncol. 2018; 9(5): 430–440.Mohile S.G., Epstein R.M., Hurria A., et al. Improving communication with older patients with cancer using geriatric assessment (GA): A University of Rochester NCI Community Oncology Research Program (NCORP) cluster randomized controlled trial (CRCT). Journal of Clinical Oncology. 2018; 36.Mohile S.G., Epstein R.M., Hurria A., et  al. Improving communication with older patients with cancer using geriatric assessment (GA): A  University of  Rochester NCI Community Oncology Research Program (NCORP) cluster randomized controlled trial (CRCT). Journal of Clinical Oncology. 2018; 36.Гордеев С.С., Ковалева Ю.Ю., Расулов А.О. Методы всесторонней гериатрической оценки больных раком прямой кишки пожилого и старческого возраста. Тазовая хирургия и онкология. 2017; 7(2): 43–52.Gordeev S.S., Kovaleva Yu.Yu., Rasulov A.O. Methods of  a comprehensive geriatric evaluation of  patients with rectal cancer of  the elderly and senile age. Pelvic surgery and oncology. 2017; 7(2): 43–52.Нековаль В.М., Ефетов С.К., Царьков П.В. Гериатрический подход в лечении пациентов старческого возраста с колоректальным раком. Медицинский совет. 2021; (21–2): 72–79.Nekoval V.M., Efetov S.K., Tsarkov P.V. Geriatric approach in  the treatment of senile patients with colorectal cancer. Medical advice. 2021; (21–2): 72–79.Decoster L., Van Puyvelde K., Mohile S., et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol. 2015 Feb; 26(2): 288–300.Decoster L., Van Puyvelde K., Mohile S., et  al. Screening tools for multidimensional health problems warranting a geriatric assessment in  older cancer patients: an  update on  SIOG recommendations. Ann Oncol. 2015 Feb; 26(2): 288–300.Югай С.В., Красавина М.А., Тютрина Ю.А., Никитина Т.П., Эльмурзаев А.Б., Рыков И.В. Роль гериатрического скрининга G8 в прогнозировании осложнений лекарственной противоопухолевой терапии у пожилых пациентов. Злокачественные опухоли. 2022; 12 (1): 13–20Yugay S.V., Krasavina M.A., Tyutrina Yu.A., Nikitina T.P., Elmurzaev A.B., Rykov I.V. The role of  G8 geriatric screening in predicting complications of antitumor drug therapy in elderly patients. Malignant tumors. 2022; 12(1): 13–20Hurria A., Mohile S., Gajra A., et al. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol. 2016; 34(20): 2366–2371.Hurria A., Mohile S., Gajra A., et al. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol. 2016; 34(20): 2366–2371.Extermann M., Boler I., Reich R.R. et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012 Jul.Extermann M., Boler I., Reich R.R. et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012 Jul.Rostoft S., van den Bos F., Pedersen R., Hamaker M.E. Shared decision-making in older patients with cancer — What does the patient want? J Geriatr Oncol. 2021 Apr; 12(3): 339–342. DOI: 10.1016/j.jgo.2020.08.001.Rostoft S., van den Bos F., Pedersen R., Hamaker M.E. Shared decision-making in  older patients with cancer  — What does the patient want? J  Geriatr Oncol. 2021 Apr; 12(3): 339–342. DOI: 10.1016/j.jgo.2020.08.001.

The authors declare that there are no conflicts of interest present.