Management model for perioperative geriatric syndromes in elderly lung cancer patients_Chinese Journal of Evidence-Based Medicine

Authors：

LI Daiping , LIANG Rui , WANG Yang , LI Linlong , CHEN Yixiao , YUE Jirong , DONG Birong ,  GE Ning

Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

GE Ning, Email: grace7733@163.com

Keywords：

Elderly; Lung cancer; Perioperative period; Syndrome; Pattern

DOI：

10.7507/1672-2531.202512197

Video：

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Objective This study aims to develop and implement a patient-centered, comprehensive perioperative geriatric syndrome management model. This systematic approach seeks to optimize preoperative status, mitigate surgical stress, and promote rapid postoperative recovery, ultimately achieving dual objectives: extending healthy lifespan and ensuring surgical safety and efficacy. Methods Through systematic literature review and clinical practice summarization, a perioperative geriatric syndrome management model for elderly lung cancer patients was developed. Based on comprehensive geriatric assessment, a multidisciplinary team was established to address seven common geriatric syndromes: frailty, delirium, sarcopenia, cognitive impairment, malnutrition, dysphagia, and emotional disorders. Dynamic assessment, risk stratification, and individualized comprehensive intervention plans were formulated. Concurrently, core involvement of family members and caregivers was emphasized. Results Implementation of this comprehensive management model established a systematic intervention pathway covering preoperative, intraoperative, and postoperative geriatric syndromes, enabling dynamic monitoring and individualized management of perioperative status in elderly lung cancer patients. The model effectively integrated multidisciplinary resources, enhanced family and caregiver support capabilities, and provided institutional and human resource guarantees for seamless transition of interventions between inpatient and outpatient settings, thereby preliminarily establishing a continuous perioperative geriatric support system. Conclusion This patient-centered, comprehensive perioperative geriatric syndrome management model systematically addresses multiple geriatric syndromes in elderly lung cancer patients. It optimizes preoperative preparation, reduces surgical risks, and promotes postoperative recovery, holding significant clinical value for improving patient outcomes and quality of life. By emphasizing multidisciplinary collaboration and family involvement, this model provides a practical reference for continuous and holistic perioperative management of elderly lung cancer patients.

Citation： LI Daiping, LIANG Rui, WANG Yang, LI Linlong, CHEN Yixiao, YUE Jirong, DONG Birong, GE Ning. Management model for perioperative geriatric syndromes in elderly lung cancer patients. Chinese Journal of Evidence-Based Medicine, 2026, 26(7): 838-846. doi: 10.7507/1672-2531.202512197 Copy

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1. Wang M, Herbst RS, Boshoff C. Toward personalized treatment approaches for non-small-cell lung cancer. Nat Med, 2021, 27(8): 1345-1356.
2. Fletcher JA, Fox ST, Reid N, et al. The impact of frailty on health outcomes in older adults with lung cancer: a systematic review. Cancer Treat Res Commun, 2022, 33: 100652.
3. Yang M, Shen Y, Tan L, et al. Prognostic value of sarcopenia in lung cancer: a systematic review and meta-analysis. Chest, 2019, 156(1): 101-111.
4. Varpaei HA, Robbins LB, Farhadi K, et al. Preoperative cognitive function as a risk factor of postoperative delirium in cancer surgeries: a systematic review and meta-analysis. J Surg Oncol, 2024, 130(2): 222-240.
5. Jiang AM, Zhao R, Liu N, et al. The prognostic value of pretreatment prognostic nutritional index in patients with small cell lung cancer and it's influencing factors: a meta-analysis of observational studies. J Thorac Dis, 2020, 12(10): 5718-5728.
6. Bravo-I?iguez C, Perez Martinez M, Armstrong KW, et al. Surgical resection of lung cancer in the elderly. Thorac Surg Clin, 2014, 24(4): 371-381.
7. Hardavella G, Frille A, Theochari C, et al. Multidisciplinary care models for patients with lung cancer. Breathe (Sheff), 2020, 16(4): 200076.
8. Theodorakis N, Nikolaou M, Hitas C, et al. Comprehensive peri-operative risk assessment and management of geriatric patients. Diagnostics (Basel), 2024, 14(19): 2153.
9. Soobiah C, Daly C, Blondal E, et al. An evaluation of the comparative effectiveness of geriatrician-led comprehensive geriatric assessment for improving patient and healthcare system outcomes for older adults: a protocol for a systematic review and network meta-analysis. Syst Rev, 2017, 6(1): 65.
10. Mu?oz de Cabo C, Hermoso Alarza F, Cossio Rodriguez AM, et al. Perioperative management in thoracic surgery. Med Intensiva (Engl Ed), 2020, 44(3): 185-191.
11. Wood DE, Kazerooni EA, Aberle DR, et al. NCCN Guidelines? insights: lung cancer screening, version 1. 2025. J Natl Compr Canc Netw, 2025, 23(1): e250002.
12. Swarm RA, Youngwerth JM, Agne JL, et al. Adult cancer pain, version 2. 2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2025, 23(7): e250032.
13. 中華醫學會麻醉學分會老年人麻醉與圍術期管理學組, 國家老年疾病臨床醫學研究中心, 國家老年麻醉聯盟. 中國老年患者圍手術期麻醉管理指導意見(2020版)(一). 中華醫學雜志, 2020, 100(31): 2404-2415.
14. By the 2023 American Geriatrics Society Beers Criteria? Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria? for potentially inappropriate medication use in older adults. J Am Geriatr Soc, 2023, 71(7): 2052-2081.
15. Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev, 2017, (6): CD012020.
16. 楊卓婧, 李銀鮮, 王菊子, 等. 肺癌患者圍手術期肺康復的最佳證據總結. 護士進修雜志, 2025, 40(3): 327-333.
17. Agostini P, Naidu B, Cieslik H, et al. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax, 2013, 68(6): 580-585.
18. Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr, 2021, 40(7): 4745-4761.
19. Riba MB, Donovan KA, Ahmed K, et al. NCCN Guidelines? insights: distress management, version 2. 2023. J Natl Compr Canc Netw, 2023, 21(5): 450-457.
20. Kent EE, Rowland JH, Northouse L, et al. Caring for caregivers and patients: research and clinical priorities for informal cancer caregiving. Cancer, 2016, 122(13): 1987-1995.
21. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
22. 中華醫學會老年醫學分會. 老年患者術后譫妄防治中國專家共識. 中華老年醫學雜志, 2016, 35(12): 1257-1262.
23. Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med, 2014, 161(8): 554-561.
24. Breitbart W, Rosenfeld B, Roth A, et al. The memorial delirium assessment scale. J Pain Symptom Manage, 1997, 13(3): 128-137.
25. Malmstrom TK, Miller DK, Simonsick EM, et al. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle, 2016, 7(1): 28-36.
26. Chen LK, Woo J, Assantachai P, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
27. 崔華, 王朝暉, 吳劍卿, 等. 老年人肌少癥防控干預中國專家共識(2023). 中華老年醫學雜志, 2023, 42(2): 144-153.
28. 中華醫學會腸外腸內營養學分會老年營養支持學組. 中國老年患者腸外腸內營養應用指南(2020). 中華老年醫學雜志, 2020, 39(2): 119-132.
29. Dent E, Morley JE, Cruz-Jentoft AJ, et al. International clinical practice guidelines for sarcopenia (ICFSR): screening, diagnosis and management. J Nutr Health Aging, 2018, 22(10): 1148-1161.
30. 盧冬磊, 馮展鵬, 曹立全, 等. 老年肌少癥的運動干預. 中國組織工程研究, 2024, 28(35): 5723-5731.
31. 梁計陵, 王岑依, 司譽豪, 等. 肌少癥的運動康復機制研究進展. 中華物理醫學與康復雜志, 2021, 43(9): 848-852.
32. 王婷婷, 章新瓊, 王愛梅, 等. 非小細胞肺癌患者圍術期運動最佳證據總結. 中國全科醫學, 2021, 24(29): 3671-3677.
33. 中國老年保健協會肺癌專業委員會, 天津市醫療健康學會加速外科康復專業委員會. 老年肺癌外科治療中國專家共識(2022版). 中國肺癌雜志, 2023, 26(2): 83-92.
34. 中華醫學會麻醉學分會老年人麻醉學組, 國家老年疾病臨床醫學研究中心, 中華醫學會精神病學分會, 等. 中國老年患者圍術期腦健康多學科專家共識(一). 中華醫學雜志, 2019, 99(27): 2084-2110.
35. 中華醫學會麻醉學分會老年人麻醉學組, 國家老年疾病臨床醫學研究中心, 中華醫學會精神病學分會, 等. 中國老年患者圍術期腦健康多學科專家共識(二). 中華醫學雜志, 2019, 99(29): 2252-2269.
36. 中華醫學會麻醉學分會老年人麻醉學組, 國家老年疾病臨床醫學研究中心, 中華醫學會精神病學分會, 等. 中國老年患者圍術期腦健康多學科專家共識(三). 中華醫學雜志, 2019, 99(31): 2409-2422.
37. 陳薇, 丁芹, 陳健, 等. 肺癌手術患者營養風險調查及對臨床結局的影響. 腫瘤代謝與營養電子雜志, 2020, 7(2): 214-219.
38. 王蕊, 李婷婷, 姜桐桐, 等. 圍術期肺癌病人營養護理研究進展. 護理研究, 2023, 37(3): 466-470.
39. 中華醫學會腸外腸內營養學分會. 成人圍手術期營養支持指南. 中華外科雜志, 2016, 54(9): 641-657.
40. 石漢平, 許紅霞, 李蘇宜, 等. 營養不良的五階梯治療. 腫瘤代謝與營養電子雜志, 2015, 2(1): 29-33.
41. 蔣力, 余江燕. 圍術期肺癌病人營養護理研究進展. 現代護理醫學雜志, 2023, 2(7): 1-13.
42. Doan TN, Ho WC, Wang LH, et al. Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. J Clin Med, 2022, 11(9): 2605.
43. Zhang PP, Yuan Y, Lu DZ, et al. Diagnostic accuracy of the eating assessment tool-10 (eat-10) in screening dysphagia: a systematic review and meta-analysis. Dysphagia, 2023, 38(1): 145-158.
44. Oguchi N, Yamamoto S, Terashima S, et al. The modified water swallowing test score is the best predictor of postoperative pneumonia following extubation in cardiovascular surgery: a retrospective cohort study. Medicine (Baltimore), 2021, 100(4): e24478.
45. Steele CM, Bayley MT, Bohn MK, et al. Reference values for videofluoroscopic measures of swallowing: an update. J Speech Lang Hear Res, 2023, 66(10): 3804-3824.
46. Jaghbeer M, Sutt AL, Bergstr?m L. Dysphagia management and cervical auscultation: reliability and validity against FEES. Dysphagia, 2023, 38(1): 305-314.
47. Lee CL, Banda KJ, Chu YH, et al. Efficacy of swallowing rehabilitative therapies for adults with dysphagia: a network meta-analysis of randomized controlled trials. Geroscience, 2025, 47(2): 2047-2065.
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Chinese Journal of Evidence-Based Medicine

Management model for perioperative geriatric syndromes in elderly lung cancer patients

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