衰弱高齡病人治療新診斷癌症之共享決策－個案報告

83歲男性，過去有虛弱症、肌少症、糖尿病、胃十二指腸潰瘍和冠心病病史。近半年開始有明顯體重下降以及吞嚥障礙。藉由老年醫學科門診安排住院，進行周全性老年評估以及了解病人的4M各層面之功能狀態，發現明顯的功能衰退、營養不良及衰弱惡化。由於嚴重貧血，病人同意接受結腸纖維鏡檢查，診斷有升結腸腺癌併周遭淋巴結轉移。經會診大腸直腸外科醫師後，建議進行切除手術及接續的同步放、化療；但對於高齡衰弱且營養不良患者，治療與否成為一個兩難選擇。我們利用一些預後及風險評估工具，連同周全性老年評估的結果，與病人和家屬進行醫病共享決策，充分說明治療的利弊，並詳細了解他們的照護目標、治療期待、可接受的生活品質、和治療偏好，做成符合病人期待又帶來最佳利益的治療決定。最後，患者、他的家人和我們的團隊共同做出決策，以實現最符合患者期望的結果，同時最大限度地提高治療效果。

關鍵字

衰弱；癌症；周全性老年評估；醫病共享決策；倫理決定

並列摘要

We present the case of an 83-year-old man with a medical history of frailty, sarcopenia, type 2 diabetes mellitus, reflux esophagitis, and coronary heart disease. The patient had experienced body weight loss and swallowing disturbance for 6 months. Comprehensive geriatric assessment was first performed with considerable functional decline, malnutrition, and worsened frailty identified. Because of severe anemia, colonofiberoscopy was conducted, revealing ascending colon adenocarcinoma with lymph node metastasis. A colo-rectal surgeon was consulted, and surgical resection followed by concurrent chemoradiotherapy was recommended. However, given the patient's functional disability, malnutrition, and frailty, the decision on whether to conduct the treatment became an ethical dilemma. In addition to our routine comprehensive geriatric assessment using the 4M model, we used several prognostic tools to estimate his short-term and long-term survival, as well as the risk of complications from cancer treatment. The results of the comprehensive evaluation were discussed in detail with the patient and his family, and their care goals, treatment expectations, acceptable levels of quality of life, and treatment preferences were explored. Finally, the patient, his family, and our team shared decision-making to achieve an outcome that best met the patient's expectations while maximizing treatment benefits.

並列關鍵字

frailty ； cancer ； comprehensive geriatric assessment ； shared decision-making ； ethical decision

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