Background: Adults with cancer who are pre-frail or frail are at risk of poor outcomes. Geriatric assessment (GA) is recommended to assess and manage vulnerability and risk of frailty in older adults with cancer (≥65) and to inform referrals in supportive services, including rehabilitation. Yet, adoption of the GA in community oncology practice lags, and frailty among adults younger than 65 often goes undetected and/or unaddressed. We evaluated the feasibility of a GA-guided rehabilitation care model and assessed changes in patient-reported and performance-based outcomes after rehabilitation. Methods: Adults (≥18 years) starting systemic therapy at a community oncology practice enrolled in the study. The GA was administered online and monthly for one year. Frailty/pre-frailty was identified using a previously validated 44-item index. The oncology team was notified of frail/pre-frail patients and then made referrals to outpatient rehabilitation. Feasibility outcomes (recruitment, retention, fidelity) and participant acceptability [7 items, 0–5 Likert scale] were analyzed descriptively. Patient-reported and performance-based outcomes were examined using the pairedt-test. Results: 48% of eligible patients enrolled (N = 141), and 83% completed at least one GA. Frailty/pre-frailty was identified in 40% of the GAs, resulting in 282 referrals to rehabilitation (99% fidelity). Acceptability scores ranged from 3.5 ± 1.7 to 4.7 ± 0.6. Participants who attended rehabilitation (52%) improved significantly in outcomes measuring health-related quality of life, mobility, aerobic capacity, and strength (allp< 0.05). Conclusion: Implementing a GA-guided rehabilitation care model was feasible and acceptable to patients receiving systemic treatment. Those who attended rehabilitation experienced significant improvement in patient-reported and performance-based outcomes.
背景：处于衰弱前期或衰弱状态的成年癌症患者面临不良结局的风险。老年综合评估（GA）被推荐用于评估和管理老年癌症患者（≥65岁）的脆弱性及衰弱风险，并为支持性服务（包括康复治疗）的转诊提供依据。然而，GA在社区肿瘤临床实践中的应用仍显滞后，且65岁以下成年患者的衰弱问题常未被发现和/或处理。本研究评估了GA指导下的康复护理模式的可行性，并考察了康复治疗后患者报告结局和基于功能表现的结局变化。 方法：研究纳入在社区肿瘤诊所开始系统性治疗的成年患者（≥18岁）。通过在线方式实施GA，为期一年，每月一次。采用先前已验证的44项指标识别衰弱/衰弱前期状态。肿瘤团队会收到关于衰弱/衰弱前期患者的通知，并据此转诊至门诊康复科。对可行性结局（招募率、保留率、执行保真度）和参与者可接受性[7个项目，李克特0-5分]进行描述性分析。采用配对t检验分析患者报告结局和基于功能表现的结局。 结果：符合条件的患者中48%入组（N=141），83%完成了至少一次GA。40%的GA中识别出衰弱/衰弱前期状态，共产生282次康复转诊（执行保真度99%）。可接受性评分范围为3.5±1.7至4.7±0.6。参加康复治疗的患者（52%）在健康相关生活质量、活动能力、有氧能力和力量等结局指标上均有显著改善（所有p<0.05）。 结论：实施GA指导下的康复护理模式对于接受系统性治疗的患者是可行且可接受的。参加康复治疗的患者在患者报告结局和基于功能表现的结局方面均有显著改善。
肿瘤(癌症)患者之家