Background to assess the efficacy of comprehensive geriatric assessment (CGA) for preventing treatment-related toxicity in older people undergoing non-surgical cancer therapies. Methods MEDLINE, EMBASE and Cochrane library databases were searched from inception till January 2022 to identify randomised controlled trials (RCTs) on the incidence of toxicity measured by the Common Terminology Criteria for Adverse Events (primary outcome) and that of therapeutic modifications, early treatment discontinuation, progression-free survival, overall survival and hospitalisation (secondary outcomes). Results analysis of six RCTs published from 2016 to 2021 recruiting 2,126 participants (median age: 71–77) who received chemotherapy as the major therapeutic approach revealed 51.7% and 64.7% of Grade 3+ toxicity in the CGA and control (i.e. standard care) groups, respectively (RR = 0.81, 95% CI: 0.7–0.94, P = 0.005, I2 = 65%, certainty of evidence [COE]: moderate). There were no significant differences in the incidence of early treatment discontinuation (RR = 0.88, P = 0.47; I2 = 63%,1,408 participants, COE: low), initial reduction in treatment intensity (RR = 0.99, P = 0.94; I2 = 83%, 2055 participants, COE: low), treatment delay (RR = 1.06, P = 0.77, I2 = 0%, 309 participants, COE: moderate), hospitalisation (RR = 0.86, P = 0.39, I2 = 41%, 914 participants, COE: moderate), progression-free and overall survival with or without CGA. However, there was an association between CGA and a lower incidence of dose reduction during treatment (RR = 0.73, P < 0.00001, 956 participants, COE: moderate). Conclusions our results demonstrated that comprehensive geriatric assessment may be associated with a lower incidence of treatment-related toxicity and dose reduction compared to standard care in older people receiving non-surgical cancer treatments. Further large-scale studies are warranted to support our findings.

中文翻译：

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老年综合评估对接受抗癌治疗的老年患者不良事件风险的影响：系统评价和荟萃分析

评估综合老年评估 (CGA) 对预防接受非手术癌症治疗的老年人治疗相关毒性的效果的背景。方法 检索 MEDLINE、EMBASE 和 Cochrane 图书馆数据库，从开始到 2022 年 1 月，确定关于通过不良事件通用术语标准（主要结果）测量的毒性发生率以及治疗修改、早期治疗中止的随机对照试验 (RCT) 、无进展生存期、总生存期和住院治疗（次要结果）。对 2016 年至 2021 年发表的六项随机对照试验的结果分析，招募了 2,126 名接受化疗作为主要治疗方法的参与者（中位年龄：71-77 岁），结果显示 CGA 和对照（即标准治疗）中 51.7% 和 64.7% 的 3+ 级毒性团体，分别（RR = 0.81，95% CI：0.7–0.94，P = 0.005，I2 = 65%，证据确定性 [COE]：中等）。早期停止治疗的发生率（RR = 0.88，P = 0.47；I2 = 63%，1,408 名参与者，COE：低）、治疗强度的初始降低（RR = 0.99，P = 0.94；I2 = 83%，2055 名参与者，COE：低），治疗延迟（RR = 1.06，P = 0.77，I2 = 0%，309 名参与者，COE：中度），住院治疗（RR = 0.86，P = 0.39，I2 = 41%， 914 名参与者，COE：中度），无进展生存期和有或没有 CGA 的总生存期。然而，CGA 与治疗期间剂量减少的较低发生率之间存在关联（RR = 0.73，P < 0.00001，956 名参与者，COE：中等）。结论 我们的结果表明，与接受非手术癌症治疗的老年人的标准护理相比，全面的老年评估可能与较低的治疗相关毒性发生率和剂量减少有关。需要进一步的大规模研究来支持我们的研究结果。