医生对老年肿瘤患者老年综合征认知度调查

Questionnaire investigation of the awareness of doctors＇ attitude to geriatric syndrome in old patients with cancer

目的为进一步改善老年肿瘤患者医疗管理质量，了解老年专科医生和肿瘤内科医生对于老年肿瘤患者管理和治疗的态度与观点。方法采用面对面问卷填写方式对四个单位老年病区进行调查。共发放148份问卷，收回有效问卷128份。受访医生中肿瘤内科医生和老年科医生各64名。结果在治疗现状方面，9．38％（6／64）的老年科医生和25％（16/64）的肿瘤内科医生认为治疗适当。39．06％（25／64）的老年科医生在诊治老年肿瘤患者的临床实践中关注老年综合征，而有81．25％（52／64）的肿瘤内科医生从未关注过老年综合征（P=0．011）。肿瘤科医生和老年科医生不同程度关注营养不良（100．00％，128／128）、移动能力障碍（65．63％，84／128）和认知功能损害／情绪障碍（89．06％老年科医生比75．00％肿瘤科医生，P=0．038）3项老年综合征与放/化疗不良反应的关系。在治疗决策影响因素方面，老年科医生比肿瘤科医生对体能状态（70．31％比92．19％，P=0．002）和共病（79．69％比62．50%，P=0．082）的关注度差异有统计学意义。62．50％（40／64）的老年科医生和75．00%（48／64）的肿瘤内科医生均认为“老年病知识缺乏”是管理老年肿瘤患者的主要困难。仅32．81％（21／B4）肿瘤内科医生曾与老年科医生有过合作，所有的受访医生均认为建立老年肿瘤患者多学科团队管理具有可行性。在临床情景假设中，当健康老年肿瘤患者年龄为65-74岁时，选择调整性治疗的肿瘤科医生多于老年科医生（32．81％比10．94％，P=0．003）；当患者年龄为75-84岁时，选择支持治疗的肿瘤内科医生多于老年科医生（31．25％比12．50％，P=0．010）；当患者年龄≥85岁，所有的受访医生均选择给予缓和治疗。结论年龄影响老年肿瘤患者的治疗决策选择。两个专业的医生均不同程度地关注老年肿瘤患者合并的老年综合征、共患病和功能状态，并且均支持老年肿瘤患者多学科团队合作的建立。

Objective To improve the quality of the management of the elderly patients with cancer in Sichuan province,and to understand the attitudes and perspectives of elderly surgeons and oncologists for the management and treatment of elderly patients with cancer. Methods A face to face questionnaire interview was conducted with oncologists （ n=64 ） and geriatricians （n = 64 ）. 128 physicians were involved in this study. Results The cancer management and therapeutics were deemed appropriate at present by 9.38%（6/64）of the geriatrlcians and 25.00% （16/64）of the oncologists. The 39.06%（25/64）of geriatricians used to notice geriatric syndromes, while 81.25% （52/64）of oncologists never concerned about the geriatric syndrome（P=0.011）.As for the causes of the therapy-associated toxicity, oncologist versus geriatrician payed an attention to malnutrition （100.00% vs. 100.00% in both groups） ,to mobility disorders（65.63% vs. 65.63%,84/128 in both groups）, to cognitive impairment/mood disorder （89.06% in geriatrician group vs. 75.00% in oncologist group,P=0. 038）. For the factors affecting treatment decisions,a physical ability attention （oncologists vs geriatricians： 70.31% vs. 92. 19%; P = 0.002）, and comorbidity （oncologists vs geriatricians： 62.50% vs. 79.69%, P = 0. 032） had statistically significant difference. In addition, lack of geriatrics knowledge was also reported by more oncologists. However, one hundred percenl of participants wanted very much to cooperate with each other in their clinical work. When responding to the clinical scenario, the 10. 94%（7/64）of geriatrieians and 32. 81% （21/64）of oncologists chose modified treatmenl for 65-74 years old patient with cancer（P=0. 003）. When the age of the patients was 75-84 years old, only 12.50%（8/64） of geriatricians prefer end-of-life care, while 31.25% （20/64）of oncologists chose it （P=0. 010）. Conclusions Selection of treatment decisions in the elderly patients with cancer affect by ageing. Both oncologists and geriatricians are concerned with the elderly patients with cancer, ageing syndrome,total sickness and functional status. And these doctors support an establishment of a muhi disciplinary team cooperation for the elderly patients with cancer. Therefore, the establishment of mutual cooperation between the two professionals is necessary and feasible.