结直肠癌和虚弱的决策和结果:DeCaF研究
A Kler1,2, J Tay3, C Slawinski4
1University of Liverpool, UK.
Annals of the Royal College of Surgeons of England
|July 15, 2025
概括
多学科团队 (MDTs) 在脆弱结直肠癌 (CRC) 患者的资源和决策方面表现出显著的差异. 需要标准化的协议来提供公平的护理,特别是对于直肠癌病例.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 老年医学 老年医学
背景情况:
- 手术切除是非转移性结直肠癌 (CRC) 的标准.
- 大约6%的CRC患者由于虚弱而无法进行手术.
- 术前评估和决策影响脆弱患者的结果,但尚未得到充分研究.
研究的目的:
- 检查脆弱,老年CRC患者的决策过程中的变化.
- 评估英国结直肠多学科团队 (MDT) 资源的可用性和利用情况.
- 为了确定在英国不同医院对脆弱的CRC患者的护理方面的差异.
主要方法:
- 一份全英范围的问卷被分发给结直肠MDT (2021年5月至6月).
- 部分A:评估MDT结构和资源使用.
- 部分B:探索模拟结肠和直肠癌的脆弱患者的MDT决策.
主要成果:
- 二十个MDT的反应;决定是MDT驱动的 (55%) 或外科医生驱动的 (45%).
- 临床检查 (85%) 和绩效状态 (90%) 是常用的评估工具.
- 资源利用率差异很大;心声回声图仅在15%的中心可用,而心肺运动测试 (75%) 和麻醉评估 (80%) 更为常见. 虚弱度评分 (25%) 和老年评估 (5%) 没有得到充分利用. 对右侧癌症的管理比直肠癌更一致.
结论:
- 在管理脆弱的CRC患者的MDTs中,资源的可用性和利用率存在显著差异.
- 与白内障癌相比,直肠癌的决策共识较低.
- 标准化的MDT协议对于确保对复杂的CRC病例提供公平,以患者为中心的护理至关重要.
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