Frailty in der Onkologie: Neue Handlungsempfehlungen für die klinische Praxis

Was ist neu?

Definition von Frailty Als Frailty wird allgemein eine Altersfaktoren geschuldete, gesteigerte Anfälligkeit für Morbidität und Mortalität bezeichnet. Im Kontext onkologischer Behandlungen älterer Menschen erhöht Frailty aber nicht nur die Wahrscheinlichkeit für unerwünschte geriatrietypische Gesundheitsereignisse (z.B. pflegerische Institutionalisierung, Stürze), sondern auch das Risiko für Therapiekomplikationen wie Toxizität und Unterbrechung oder Abbruch der Tumortherapie.

Identifikation von Patienten mit Frailty In der Onkologie sind Assessment und Management von Frailty jetzt unverzichtbare Bestandteile klinischen Handelns. Mehrere prospektive, randomisiert-kontrollierte Studien (RCT) an älteren Patienten mit onkologischer Systemtherapie haben jüngst gezeigt, dass die strukturierte Erfassung von Frailty im Rahmen eines multidimensionalen geriatrischen Assessments, mit anschließender Anpassung von Therapiedosis oder -regime, sowie der Behandlung individueller Frailty-Faktoren dabei hilft, Häufigkeit und Schwere ungünstiger Endpunkte einer onkologischen Therapie zu reduzieren.

Assessment und Management von Frailty im onkologischen Behandlungskontext In neuen Leitlinien der American Society of Clinical Oncology (ASCO) bzw. der Arbeitsgemeinschaft der Medizinischen Fachgesellschaften (AWMF) wurden die Studienergebnisse unlängst aufgenommen und entsprechende Handlungsempfehlungen mit hohem Evidenz- und Empfehlungsgrad ausgesprochen. Um die Implementierung eines gezielten Frailty-Assessments und -Managements in onkologischen Kliniken und Praxen zu erleichtern, wurde von der ASCO ein neues, anwendbares „Praktisches Geriatrisches Assessment“ (PGA) vorgeschlagen.

Abstract

Frailty is a clinical condition associated with aging and resulting in increased risk of adverse outcomes upon exogenous or endogenous stressors. In oncology, cancer treatment itself can be a stressor event. In older cancer patients, frailty therefore not only enhances the probability of age-related health events such as institutionalization or falls, but also of treatment complications such as toxicity and interruption or discontinuation of therapy. As demonstrated by recent randomized-controlled trials conducted in older cancer patients receiving systemic treatment, the evaluation of frailty by geriatric assessment (GA) followed by an adjustment of the oncological therapy as well as targeted frailty interventions help to improve cancer treatment tolerability and feasibility. Based on these data, the American Society of Clinical Oncology (ASCO) updated the clinical practice guidelines for the assessment and management of vulnerabilities in older adults receiving systemic cancer therapy. The guideline recommends the use of a new GA-tool named ‘practical geriatric assessment’ (PGA) to foster the implementation of GA-based frailty assessment and management in routine cancer care. This article describes the background and key aspects of these recent advances.

Schlüsselwörter

geriatrisches Assessment - Tumorkonferenz - Chemotherapie - Therapietoxizität - Frailty

Keywords

geriatric assessment - tumor conference - chemotherapy - treatment toxicity - frailty

Publication History

Article published online:
15 August 2024

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