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  • Chinese Medical Association Clinical Pharmacy Branch, Chinese Medical Education Association Pharmacy Administration Professional Committee, Clinical Rational Drug Use Professional Committee
    Herald of Medicine. 2024, 43(9): 1355-1368. https://doi.org/10.3870/j.issn.1004-0781.2024.09.001

    Nebulization therapy is a direct drug administration process that turns liquid medications into mist that can be inhaled into the lungs and respiratory tract and is an important strategy for various respiratory problems and diseases. In recent years,there has been a high prevalence of respiratory diseases in China,so the popularity of nebulization at home and at basic-level hospitals has increased significantly. Therefore, the standardized application and rational administration of nebulization therapy should be concerned seriously. Led by the Chinese Medical Association Clinical Pharmacy Branch,the updating work of the Expert Consensus on the Rational Use for Inhaled Medicines Administrated by Nebulizers (2024 Edition) was carried out jointly by Chinese Medical Education Association Pharmacy Administration Professional Committee and Clinical Rational Drug Use Professional Committee.This consensus comprehensively introduces the drug delivery characteristics,safety and effectiveness,medication indications,application process and pharmaceutical care of nebulization therapy,the selection of small-volume nebulizers,new drugs for nebulized inhalation,recommended dosing regimens for respiratory diseases,etc.It aims to offer professional guidance for all healthcare providers of standardized nebulization therapy and rational administration.

  • DU Shan, LI Jinqi, YANG Yong, CHEN Min, BIAN Yuan, LIU Xinxia
    Herald of Medicine. 2024, 43(9): 1398-1404. https://doi.org/10.3870/j.issn.1004-0781.2024.09.007

    Objective To summarize the exploration and current situation of pharmaceutical service fees in China,to analyze it in conjunction with practices in foreign countries,and to provide references for further improvement of pharmaceutical service fees in China. Methods The official websites of the National Health Commissi, National Healthcare Security Administration, and their provincial braches were retrieved to summarize the changes in policies in China and the latest pharmaceutical service fees policies in each province.At the same time,databases such as CNKI,VIP,and Pubmed were searched to summarize research on pharmaceutical service fees. Results There were some studies in China on the calculation of pharmaceutical service costs and fee standards,but they mostly focused on pharmacy dispensing services,with less discussion on the technical and labor value of specific pharmaceutical services,while international research in this area was relatively abundant.Currently,eight provinces and one municipality directly under the central government have issued medical service price items related to pharmaceutical service,with differences in fee items,fee standards,medical insurance payment ratios,and monitoring and evaluation indicators. Conclusions The inclusion of pharmaceutical services in the national medical pricing system recognizes the transformation of pharmaceutical services and the value of pharmacists.However,it is still in the early stages,and there is room for improvement and enhancement.

  • ZHOU Lijuan, WEN Xianxiu, WU Haiyan, JIANG Rong, WANG Xuan, GOU Li, LYU Qin, ZHANG Dingding, HUANG Qian, WU Xingwei
    Herald of Medicine. 2024, 43(9): 1509-1518. https://doi.org/10.3870/j.issn.1004-0781.2024.09.028

    Objective To construct and validate a risk prediction model for poor inhalation in chronic obstructive pulmonary disease (COPD) patients receiving inhaler therapy,providing a decision support tool for personalized prevention of poor inhalation. Methods A cross-sectional study was conducted to collect data related to COPD patients receiving inhaler therapy,forming a dataset.The dataset was randomly divided into a training set and a test set in a ratio of 4:1.Four different methods for missing value imputation,3 methods for variable feature selection,and 18 machine learning algorithms were employed to successfully construct 216 models on the training set.The monte carlo simulation method was used for resampling in the test set to validate the models,with the area under curve (AUC),accuracy,precision,recall,and F1 score used to evaluate model performance.The optimal model was selected to build the poor inhalation prediction platform. Results A study involving 308 patients with COPD found that 135 (43.8%) were at risk of adverse inhalation.Using 33 predictor variables,216 risk prediction models were developed.Of these models,the ensemble learning algorithm yielded the highest average AUC of 0.844,with a standard deviation of 0.058 [ 95%CI=(0.843,0.845)].The differences in predictive performance among the 216 models were statistically significant (P<0.01).Under the ensemble learning algorithm,adherence to inhaler use(38.087 4%),inhaler satisfaction(25.680 1%),literacy(24.031 3%),number of inhalers(5.482 3%),age(4.204 5%)and number of acute exacerbations in the past year(2.184 7%)contributed most to the predictive model.The model exhibited superior performance,with an AUC of 0.869 3,an accuracy of 83.87%,a precision of 86.96%,a recall of 74.07%,and an F1 score of 0.8. Conclusion This study has developed a predictive model for poor inhalation risk in COPD inhaler therapy patients using machine learning algorithms,which exhibits strong predictive capabilities and holds potential clinical application value.

  • DU Guangxin, FU Wei, ZHOU Xuehong, LIU Dong, LI Juan, LONG Ping
    Herald of Medicine. 2024, 43(9): 1376-1380. https://doi.org/10.3870/j.issn.1004-0781.2024.09.003

    This article introduced the background,drafting process,and main content of the Interim Measures for the Management of Surplus Drugs in Medical Institutions of Hubei Province(referred as the Measures).It focused on explaining the definition of surplus drugs and analyzing the requirements for drug dismantling,surplus drug billing,recovery and use procedures,special fund management,and duties and responsibilities of management departments. This paper aimed to guide readers to learn the Measures, understand the Measures and implement the Measures. It would help to improve the efficiency of medical resources,ensure medication safety,reduce patients' medication burden,and promote the rational use of medical insurance funds.

  • XIE Wenzheng, XIAO Jie, HUANG Shuting, XU Ping
    Herald of Medicine. 2024, 43(9): 1405-1410. https://doi.org/10.3870/j.issn.1004-0781.2024.09.008

    Objective The purpose of this study is to investigate patients' willingness to pay for pharmacy services and its influencing factors by reviewing and analyzing the literature related to pharmacy services. Methods Relevant studies were identified by searching the CNKI database,Wanfang database,Sinomed,PubMed,and Web of Science from January 2010 to December 2023.Literature in both English and Chinese that elicited patient willingness to pay for pharmacy services was included.An analysis was carried out according to the year of publication,country,methodology,patient willingness to pay,and its influencing factors. Results 24 studies were retrieved,and the average willingness to pay ranged from $1 to $20.Patient willingness to pay for pharmacy services is influenced by various factors.Higher willingness to pay for pharmacy services is associated with higher income and education levels and lower out-of-pocket spending. Conclusions It is generally found that patients' willingness to pay is generally influenced by their income level,educational background,and medical insurance.We suggest that pharmacy services should be promoted and integrated into medical insurance coverage,and pharmacists' competency should be enhanced to accelerate the high-quality development of pharmacy services.

  • Herald of Medicine. 2024, 43(3): 321-333. https://doi.org/10.3870/j.issn.1004-0781.2024.03.001
    Objective To provide a comprehensive evaluation framework for assessing the value of clinical pharmacy services, and to offer guidance for improving and optimizing the provision of clinical pharmacy services. Methods The World Health Organization (WHO) handbook for guideline development were used for the research design of the evaluation system guidelines. The Delphi method was used to identify clinical questions. The secretariat conducted systematic searches and collected existing evidence for the identified questions. Systematic reviews and evidence grading were performed,and evidence summaries were created. Based on the analysis report from the secretariat,the writing group developed specific guidelines. The Australian Joanna Briggs Evidence Level System, and the Grading of Recommendations Assessment,Development,and Evaluation (GRADE) system recommended by the World Health Organization in 2004 were used to grade the quality of evidence for this guideline. Consensus on recommendations and evidence grading was reached through a Delphi process. Finally,the practice Guidelines for the Value Evaluation of Clinical Pharmacy Services (First Edition) were established. Results More than 100 experts participated in the voting process by the Delphi method,and 23 value indicators for assessing the value of clinical pharmacy were included in the guidelines. The included indicators were searched and relevant systematic reviews,meta-analyses,network meta-analyses,and original studies were identified following the PICO principle. The Guideline Development Committee reviewed each search strategy. Consensus was reached on the definition and content of the included indicators,and 20 recommendations for the value assessment of clinical pharmacy were determined. Conclusion This guideline provides a set of indicators for measuring the quality and effectiveness of clinical pharmacy services,which is of great significance for improving the quality of clinical pharmacy services.
  • LI Dongmei, YANG Qian, SUN Shuimei, HE Ling, WU Dirong, LIU Mingji, CHEN Pingping, WANG Libin, WANG Zhongyuan, ZHANG Hong, ZHU Zhu, BAI Xue, SHENG Changcheng, ZHANG Jiaxing, LU Lei, WANG Xue, CHEN Qi
    Herald of Medicine. 2024, 43(9): 1410-1415. https://doi.org/10.3870/j.issn.1004-0781.2024.09.009

    Objective To investigate the current status and awareness of pharmaceutical services in hospitals in Guizhou province and to provide a reference for exploring and carrying out pharmaceutical service fees. Methods The questionnaire was designed by the “wjx.cn” website.Three kinds of questionnaires were designed for pharmacists,doctors,nurses,and patients as the research objects,with corresponding differences in some questions,and promoted on WeChat,Dingxiangyuan,and other network platforms. Results A total of 655 questionnaires were collected,and 639 valid questionnaires were recovered,with an effective recovery rate of 97.56%.324 pharmacists(50.70%),82 doctors and nurses(12.83%),233 patients(36.46%) were surveyed.The average approval score of these three groups of respondents on pharmaceutical service fees was 4.67,4.23,and 4.22,respectively(full score:5). Conclusions Overall,pharmacists' professional services have received support from medical staff and patients.However,patients' pharmaceutical service projects currently focus on dispensing services.The recognition of pharmacists' work and the public's awareness of pharmaceutical services can be improved by enhancing the professional ability of pharmacists,strengthening publicity and guidance,and exploring "Internet + pharmaceutical services",etc.,to promote the sustainable development of pharmaceutical services.

  • ZHENG Jianling, YIN Yanchao, TANG Ying, GUO Min, LIU Dong, LI Juan
    Herald of Medicine. 2024, 43(9): 1502-1508. https://doi.org/10.3870/j.issn.1004-0781.2024.09.027

    To define the concept of digital-intelligent pharmacy from three aspects:digital technology,digital intelligence,and data intelligence.By sorting out the development process of hospital pharmacy from informatization to digitalization and then to intelligence in recent years,and combining with the practical experience of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in the field of digital pharmacy,this paper discussed the meaning of digital pharmacy and provided new ideas and new assistance for the transformation of hospital pharmacy.Digital pharmacy refers to pharmacists with digital intelligence,who apply digital technology to hospital pharmacy scenarios,combining their own pharmaceutical knowledge,to obtain and produce data intelligence,and realize the digital transformation of hospital pharmacy.Digital pharmacy has become an emerging interdisciplinary subject in hospital pharmacy,which can promote the high-quality development of hospital pharmacy in the future and is a new productive force in hospital pharmacy.

  • LIU Qian, REN Biqi, NIU Jiang, LIN Shuzhi, LEI Shuang, LIU Wei, ZHU Xiaoying, YIN Lin, FENG Bianling
    Herald of Medicine. 2024, 43(9): 1416-1422. https://doi.org/10.3870/j.issn.1004-0781.2024.09.010

    Objective To investigate the current awareness of pharmaceutical service fees among pharmacists in hospitals of Shaanxi province to provide a theoretical basis and decision-making framework for establishing such fees in hospitals of various provinces and cities in the future. Methods A questionnaire survey was conducted among 47 representative hospitals and 53 pharmacists within these hospitals in Shaanxi province.The results were analyzed using differential analysis. Results In most hospitals of Shaanxi province,pharmaceutical services are not provided or not charged for,indicating a lack of practical experience in the establishment of pharmaceutical service fees.Among hospitals that provide and charge for pharmaceutical services,there remains a need for uniformity in specific service content and fee standards,clear regulatory policy support,and a unified evaluation system.Significant differences exist among hospitals of different levels and types in terms of their capacity to provide pharmaceutical services and the forms in which they are offered.There is inconsistency among pharmacists within hospitals regarding crucial aspects of establishing pharmaceutical service fees,and further enhancement is needed in their awareness of relevant policies and the latest guidelines. Conclusions There is considerable room for improvement in establishing pharmaceutical service fees in hospitals of Shaanxi province.Stakeholders should promptly establish and standardize the fee establishment model,differentiate the fee standards for various services,enhance the publicity and dissemination of relevant document requirements to support the smooth implementation of pharmaceutical service fee policies.

  • The Professional Committee of Intravenous Drug Formulation Management of Chinese Pharmaceutical Association
    Herald of Medicine. 2024, 43(9): 1369-1375. https://doi.org/10.3870/j.issn.1004-0781.2024.09.002

    In recent years,the National Health Commission has set improving the standardized utilization rate of intravenous infusion for inpatients as one of the goals for improving medical quality and safety.The rational allocation of intravenous drugs in medical institutions is a prerequisite for the standardized use of intravenous infusion.Therefore,it is imperative to establish a suitable evaluation and selection system for intravenous drugs.Based on the previous work,the Professional Committee of Intravenous Drug Formulation Management of the Chinese Pharmaceutical Association organized experts to discuss the dimension setting,score distribution,and scoring rules of the Quantitative Record Sheet for Evaluation and Selection of Intravenous Drug and compiled the Expert consensus on Evaluation and Selection of Intravenous Drug in Medical Institution.The aim is to provide references for selecting intravenous drugs and clinical medication decisions in medical institutions,ensuring that patients receive safe,effective,economical,and appropriate drug treatment.

  • ZHAO Yang, SHU Yongquan, CHEN Jing, CHEN Lu, BIAN Yuan, TAN Xin
    Herald of Medicine. 2024, 43(9): 1423-1428. https://doi.org/10.3870/j.issn.1004-0781.2024.09.011

    Home enteral nutrition(HEN) has demonstrated advantages in improving patients' quality of life and reducing medical costs.It is widely embraced in the United States,Europe,and other regions.Due to individual differences in the characteristics of HEN preparations,drug interactions,and variations in patient nutritional status,patients need pharmaceutical supervision from a nutritional support pharmacist(NSP) when using HEN.HEN in China is still in its infancy.There are no corresponding norms and guidelines for NSP participation in HEN and a need for specific operating standards.This article delves into the current situation of NSP participation in HEN management,the content of pharmaceutical care,and the value of pharmaceutical services.It aims to offer valuable reference evidence for future practice and research.

  • JIAO Quanhui, ZHONG Lingyun, CHENG Ziwen, LYU Xiaobin, ZHANG Changhua
    Herald of Medicine. 2024, 43(3): 408-413. https://doi.org/10.3870/j.issn.1004-0781.2024.03.014

    Ferroptosis is a unique iron-dependent cell death pattern,a novel death phenotype distinct from apoptosis,various forms of necrosis,and autophagy.Numerous active ingredients extracted from traditional Chinese medicine have been found to exert anti-cancer effects by inducing ferroptosis in various cancers.An increasing number of studies have found that the regulation of ferroptosis can influence the sensitivity of tumor cells to drugs and even reverse drug resistance.When combined with chemotherapy drugs such as cisplatin,5-FU and gemcitabine, some natural products enhance cancer cells’ sensitivity to chemotherapeutic drugs by inducing ferroptosis.This paper mainly summarizes traditional Chinese medicine and its natural products that can exert anti-cancer effects by inducing ferroptosis,providing new insights for cancer treatment and drug resistance reversal.Additionally, it contributes to exploring the potential advantages of traditional Chinese medicine, thereby expanding its scope of application.

  • CHAI Yuhui, YANG Yunyun, CHEN Jingxia
    Herald of Medicine. 2024, 43(10): 1552-1561. https://doi.org/10.3870/j.issn.1004-0781.2024.10.004

    Objective To systematically evaluate the efficacy and safety of the ceftazidime-avibactam (CAZ-AVI) regimen versus other regimens for treatment of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections, and to provide an evidence-based foundation for drug selection in clinical CRE bloodstream infections. Methods A computerized search was conducted in Pubmed, Embase, Cochrane Library, Web of Science, Wanfang Medical Network, CNKI and China Science and Technology Journal Database for literature on CAZ-AVI for CRE bloodstream infections from the inception of each database up to November 2023. The literature quality evaluation and data extraction were independently performed by two researchers. A meta-analysis was performed using Review Manager 5.3 software. Results A total of 15 English articles and 1 580 patients were included. The results showed that the clinical cure rate [OR=3.32, 95%CI=(2.25, 4.90), P<0.000 01] and microbial clearance rate [OR=3.00, 95%CI=(1.15, 7.81), P=0.02] were significantly higher in the CAZ-AVI group than in the control group, and the 28 d/30 d all-cause mortality rate of patients in the CAZ-AVI group was lower than that of the control group [OR=0.38, 95%CI=(0.29,0.51), P<0.000 01]. The recurrence rates of infection in the two groups were equivalent and statistically non-significant [OR=0.75, 95%CI=(0.39,1.42), P=0.37]. Subgroup analysis indicated that the CAZ-AVI group had a lower all-cause mortality rate than the tigecycline group [OR=0.20, 95%CI=(0.11,0.39), P<0.000 01]. In terms of safety, the incidence of adverse events between the two groups was comparable and statistically non-significant [RR=0.47, 95%CI=(0.20,1.07), P=0.07]. However, the nephrotoxicity was significantly lower in the CAZ-AVI group than in the control group [OR=0.36, 95%CI=(0.21,0.64), P=0.000 5]. Conclusion Based on the findings of the current study, CAZ-AVI offers potential clinical advantages in the treatment of CRE bloodstream infections by improving clinical cure rates and reducing mortality rates.

  • HU Qi, YANG Shiyu, LIU Qiang, HU Xiao, TAO Xue, YI Hui, BIAN Yuan, LONG Enwu
    Herald of Medicine. 2024, 43(10): 1572-1577. https://doi.org/10.3870/j.issn.1004-0781.2024.10.006

    With the widespread use of carbapenem antibiotics, the clinical detection rate of carbapenem-resistant Gram-negative bacilli has shown a significant increase. Carbapenem-resistant Gram-negative bacilli isolates are often extensively or fully resistant, resulting in limited antimicrobial treatment options and high morbidity and mortality rates, posing a serious public health threat. The clinical treatment of carbapenem-resistant Gram-negative bacilli includes the use of single or combination antimicrobials such as polymyxin, tigecycline, and fosfomycin. A number of new antimicrobials and therapeutic approaches are under development. The clinical management of carbapenem-resistant Gram-negative infections is severely challenged by the limited choice of antimicrobial agents. Therefore, this article reviews the current status and progress of antimicrobial treatment for carbapenem-resistant Gram-negative bacilli to providing clinical reference.

  • YIN Jiaxin, SONG Yuxiao, ZHANG Bicheng
    Herald of Medicine. 2024, 43(3): 352-359. https://doi.org/10.3870/j.issn.1004-0781.2024.03.004

    Immunotherapy,represented by immune checkpoint inhibitors (ICIs),has significantly changed the treatment strategy of non-small cell lung cancer (NSCLC) and has become an important therapy for all stages of NSCLC.However,there is an urgent need for further clarification regarding ICIs for elderly patients with advanced NSCLC.Treatment strategies for ICIs were guided by assessing survival data of elderly NSCLC patients included in clinical trials.We concluded that treatment regimens such as ICI monotherapy,dual immunotherapy,and ICIs combined with chemotherapy could be carried out in elderly NSCLC patients with a performance status (PS) score <2.Elderly NSCLC patients treated with ICIs could achieve similar benefits as younger patients and are generally well tolerated.However,as age increases (especially above 80 years),the efficacy decreased and the incidence of immune-related adverse events (irAEs) gradually increased.Therefore,ICIs should be carefully selected for advanced NSCLC patients at an advanced age.Compared to age,PS was a key factor causing patients to be excluded from ICIs and poorer survival outcomes.In conclusion,immunotherapy in elderly patients with advanced NSCLC is extremely challenging,and many issues still need further exploration in this field.

  • WANG Xinli, XUE Yan
    Herald of Medicine. 2024, 43(3): 360-365. https://doi.org/10.3870/j.issn.1004-0781.2024.03.005

    Elderly breast cancer patients have different characteristics from young breast cancer patients,and their treatment faces many challenges.The treatment for elderly patients with breast cancer is often based on retrospective studies or evidence of general population lacks Class I clinical evidence. This article summarized the relevant clinical studies of advanced breast cancer with different molecular subtypes,explored the optional treatments and development directions for advanced elderly breast cancer,and provided reference for clinicians.

  • LIU Ying, SUN Pujiao, XU Kaiju, YANG Renguo, YANG Xingxiang
    Herald of Medicine. 2024, 43(10): 1578-1582. https://doi.org/10.3870/j.issn.1004-0781.2024.10.007

    Objective To explore the clinical characteristics and treatment strategies of patients with Carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection. Methods A retrospective analysis was conducted on demographic information, microbiological data, and clinical characteristics of patients with CRE bloodstream infections in Sichuan Provincial People's Hospital from September 2018 to December 2021. Results A total of 53 cases of CRE bloodstream infections were identified, with a treatment failure rate of 47.2%. Patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) had a worse prognosis (P<0.05). Patients with treatment failure showed higher levels of procalcitonin, C-reactive protein, lactate dehydrogenase, and prolonged prothrombin time, along with lower levels of globulin (P<0.05). Among the 53 patients included in the outcome analysis following drugs, there was no statistically significant difference between monotherapy (n=15) and combination therapy (n=38) (P>0.05). Treatment regimens containing tigecycline were not superior to other strategies without tigecycline (P>0.05). Univariate analysis results indicated that the prognosis of CRE bloodstream infection was associated with endotracheal intubation, central venous catheterization, bacterial species which lead infection, comorbidities of the hepatobiliary system, and infection occurring after ICU admission (P<0.05). Health issues involving the hepatobiliary system and ICU-onset admission were independent risk factors for the prognosis of CRE bloodstream infection (P<0.05). Conclusion Patients with CRE bloodstream infections have a high mortality rate, and those with elevated procalcitonin and C-reactive protein levels indicate a poor prognosis. The use of tigecycline in combination or alone may not be the optimal treatment choice for CRE-related BSI.

  • Expert Group on Rational Evaluation and Improvement of Clinical Use of Traditional Chinese Medicine
    Herald of Medicine. 2024, 43(6): 841-849. https://doi.org/10.3870/j.issn.1004-0781.2024.06.001

    The eighteen incompatible medicaments and nineteen counteraction theory belongs to the category of compatibility contraindications in Traditional Chinese Medicine (TCM), and has been used as a basis for rational evaluation in the review and evaluation of TCM prescriptions for a long time. However, there is constant controversy on the theory from perspectives of the historical origins, content categories, modern research, clinical applications, and ancient and modern academic. Thus the author gathered opinions medical and pharmaceutical experts from various types of medical institutions across the country based on literature review, expert interviews, and questionnaire surveys. The improved Delphi method and evidence review evaluation system were used to classify and understand, the eighteen incompatible medicaments and nineteen counteraction theory in a hierarchical manner. The core principles of this theory were analyzed using a classification model of "toxic-toxic" combination, "toxic-non toxic" combination and "non toxic-non toxic" combination. The recommendations for clinical safety risk assessment were formed on various types of evidence. The final consensus consists of three parts and a total of 19 statements, aiming to provide reference for the scientific and rational use of herbal medicines and the high-quality development of the industry.

  • WANG Liqiang, DENG Haiyi, LIU Ming, LIN Xinqing, XIE Xiaohong, XIE Zhanhong, QIN Yinyin, OUYANG Ming, ZHOU Chengzhi
    Herald of Medicine. 2024, 43(3): 365-373. https://doi.org/10.3870/j.issn.1004-0781.2024.03.006

    Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS) score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor tolerance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-disciplinary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.

  • SUN Yiting, TENG Zan, LIU Yunpeng, QU Xiujuan
    Herald of Medicine. 2024, 43(3): 374-380. https://doi.org/10.3870/j.issn.1004-0781.2024.03.007

    Senescence is the major risk factor that promotes development of different stages of chronic liver diseases and is closely related to occurrence of hepatocellular carcinoma.Significant differences consist in clinicopathological features and tumor microenvironment between elderly and young patients with hepatocellular carcinoma.With rapid development of systemic therapy,immune checkpoint inhibitors combined with targeted therapy have greatly improved the prognosis of patients with advanced hepatocellular carcinoma.The selection of treatment decisions for elderly patients with hepatocellular carcinoma requires to consider unique age-related issues.Adequate communication and necessary evaluation should be carried out before making decisions.Elderly patients with hepatocellular carcinoma are speculated to benefit from combination immunotherapy based on age subgroup analysis of large clinical studies.However,data of effects and security obtained from clinical trials has certain limitations when being applied in elderly populations of real world.The optimal therapeutic strategies for elderly patients with hepatocellular carcinoma still remain to be further explored in large-scale prospective clinical studies.