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논문KCI 등재

노인 암 환자의 평가

Assessment of elderly cancer patients and its clinical importance

김민정|김재원
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2008.07|Obstetrics & Gynecology Science|제51권 제7호|pp. 691-706

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참고문헌

키워드

암CancerFrail elderlyGeriatric assessment연약한 노인포괄적 노인평가
주제분류산부인과학

초록

인구 고령화가 급속히 진행되고 있고, 암질환 발병의 절반 이상이 노인 인구 집단에서 발생하고 있어, 노인 암 환자를 진료하는 것이 부인 종양학 분야의 일상이 되고 있다. 그러나, 노인 암 환자를 대상으로 시행된 임상 시험이나 연구결과들이 부족한 상태로, 노인 암 환자들은 많은 경우 불충분한 치료를 받고 있다. 또한, 노인 인구 집단은 기능 보유능력이 다양하며 치료 중 부작용이나 독성을 나타내는 정도가 다양하므로 기능적 평가인 포괄적 노인평가를 수행하여 개개인의 기능 상태에 따라 적절한 치료를 시행해야 한다. 포괄적 노인평가는 기능상태, 동반질환, 인지기능, 정서상태, 영양상태, 사회적 지지 및 약물복 용 등 여러 분야에 걸쳐 노인 환자 개개인을 평가하는 것이다. 현재 포괄적 노인평가가 노인 암 환자를 진료/치료함에 있어 임상적 의미를 가진다는 점이 다수의 논문들에서 보고되고 있으며, 노인 평가를 보다 현실적으로 수행하기 위한 실제적이고 간략한 노인평가 도구를 개발하는 노력을 하고 있다. 실제 부인 종양학 분야의 노인 환자를 치료할 때 포괄적 노인평가 후 환자의 기능적 상태와 기대수명을 고려하여 치료 방법을 선택할 수 있겠다. 기능적 결함이 거의 없는 환자의 경우 기존의 젊은 환자를 대상으로 시행하는 표준치료를 적용할 수 있으나, 기능적 결함이 심한 ‘무른’ 상태라면, 덜 침습적인 수술이나 단독요법의 항암치료와 같은 변형된 치료를 선택할 수 있다. 향후 포괄적 노인평가를 이용하여 환자 상태에 따른 각각의 치료방법 선택과 치료결과에 미치는 영향에 대한 구체적인 검증과 가이드라인을 제시하기 위한 전향적인 연구가 필요하다. 또한, 한국형 평가도구 및 암 환자 특이적인 혹은 치료 특이적인 평가측정도구 마련이 필요하다.

Abstract

More than half of new cancers occur in the elderly and population is rapidly being aged. As a result, care of older patients constitutes an important part of the everyday practice for the adult oncologist. With few guidelines, the older patients are too much often under treated and have wide heterogeneity in the ability to undergo aggressive therapy. Comprehensive geriatric assessment (CGA) is helpful in evaluating the functional age of the elderly patients and guiding the adequate treatment in clinical practice, according to tolerance to cancer therapy and their life expectancy. For the healthy elderly patient with minimal comorbidity and near-normal functional reserve, aggressive treatment including full-dose chemotherapy is warranted and canyield results similar to those in young patients in gynecologic oncology part. The modified treatment plan, such as less aggressive or invasive operation and single-agent regimen of chemotherapy, can be considered to ‘frail’ patients with much impaired function. Many studies have shown promising results and more brief and practical tools of geriatric assessment are being developed. Prospective trials evaluating the utility of CGA to guide intervention to improve the quality of cancer care in the elderly cancer patients are justified. In addition, Korean version, cancer-specific or treatment-specific tools of geriatric assessment need to be constructed.

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