We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients age ii75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficitaccumulation approaches, were randomized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end of life (EOL) goals of care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consultation plus standard care (n = 60) or standard care alone (n = 100). Median age was 80.4 years (SD = 4.2). Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at one year compared to standard care (difference: 2.9%, 95% CI = -9.5% to 15.2%, p = 0.65), and did not significantly reduce the incidence of ED visits, hospitalizations, or days in hospital. Consultation did improve the odds of having EOL goals of care discussions (odds ratio = 3.12, 95% CI = 1.03 to 9.41) and was valued by surveyed hematologiconcology clinicians, with 62.9%-88.2% rating consultation as useful in the management of several geriatric domains.

中文翻译：

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老年血液系统恶性肿瘤老年咨询与标准护理的随机对照试验。


我们对患有血液系统恶性肿瘤的老年人进行了一项随机对照试验，以确定我们的肿瘤诊所中纳入老年科医生咨询以及标准护理的影响。从 2015 年 2 月到 2018 年 5 月，年龄 ii75 岁、不符合移植资格、在达纳法伯癌症研究所（马萨诸塞州波士顿）就淋巴瘤、白血病或多发性骨髓瘤进行初步咨询的患者符合资格。根据表型和缺陷累积方法进行分类的虚弱前和虚弱患者被随机分配接受标准肿瘤治疗，并咨询或不咨询老年科医生。主要结局是一年总生存率。次要结局包括随访 6 个月内计划外的护理利用以及记录的护理讨论的生命终止 (EOL) 目标。调查了临床医生对老年科咨询的印象。 160 名患者被随机分配接受老年咨询加标准护理 (n = 60) 或单独标准护理 (n = 100)。中位年龄为 80.4 岁（SD = 4.2）。在随机接受老年科咨询的患者中，48 人 (80%) 至少完成了一次老年科医生的就诊。与标准护理相比，会诊并没有改善一年后的生存率（差异：2.9%，95% CI = -9.5% 至 15.2%，p = 0.65），并且没有显着减少 ED 就诊、住院或住院天数的发生率。医院。咨询确实提高了实现 EOL 护理讨论目标的几率（比值比 = 3.12，95% CI = 1.03 至 9.41），并且受到接受调查的血液肿瘤临床医生的重视，62.9%-88.2% 的人认为咨询对治疗一些老年病有用。域。