Independence and health related quality of life in 200 onco-geriatric surgical patients within 6 months of follow-up: who is at risk to lose?

• Published in: European journal of surgical oncology Vol. 42; no. 12; pp. 1890 - 1897
• Main Authors: Baier, Peter, Ihorst, Gabriele, Wolff-Vorbeck, Guido, Hüll, Michael, Hopt, Ulrich, Deschler, Barbara, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2016
• Subjects: Activities of Daily Living; Adenocarcinoma - epidemiology; Adenocarcinoma - surgery; Aged; Aged, 80 and over; Body Mass Index; Cancer; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - surgery; Diarrhea - epidemiology; Digestive System Neoplasms - epidemiology; Digestive System Neoplasms - surgery; Emotions; Female; Geriatric Assessment; Health Status; Hematology, Oncology and Palliative Medicine; Humans; Independent Living; Karnofsky Performance Status; Male; Multivariate Analysis; Postoperative Complications - epidemiology; Postoperative Period; Prognosis; Prospective Studies; Quality of Life; Regression Analysis; Risk Assessment; Surgery; geriatric assessment; cancer; quality of life; surgery; Geriatric assessment; Surgery; Quality of life; Cancer
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.07.013

Abstract Aims Comprehensive Geriatric Assessment (CGA) provides information on aspects of older patients to predict risks and benefits of interventions. Methods To evaluate the application of CGA (including quality of life (QOL)) for the risk prediction of postoperative dependence and QOL in elderly patients with malignant tumours, a prospective observational study including 200 patients >70 years was performed. The primary outcome was postoperative activities of daily living (ADL<95), secondary outcome was QOL at 6 months. Multivariate regression was performed to assess the impact of associated factors (socio-demographic, clinical (performance, nutrition, comorbidities, POSSUM, laboratory variables), functional, cognitive variables (CGA), resilience, QOL (EORTC QLQ-C30)). Results Median age of patients was 75 (70-88) years with 69% males. The majority of operations were for colon carcinoma; morbidity was 24.8%, mortality 1.5%. Impairment in ADL (<95) preoperatively was 6.7% (13/195), it rose to 9.7% (12/124). Analyzing factors predicting loss of ADL, the following reached significance: BMI (OR: 1.7; p=0.019), ADL (OR: 0.67; p=0.0317), and of the QLQ-C30: diarrhea (OR: 1.04; p=0.013), emotional functioning (OR: 0.91; p=0.0242), physical functioning (OR: 0.92; p=0.027). QOL paralleled ADL (pre-op: 65.4 to 67 postoperatively, respectively); predictive were: Karnofsky Index (Parameter Estimate (PE): 0.55; p=0.0003) and (QLQ-C30) emotional function (PE: 0.14; p=0.0208). Conclusions Those considered for oncologic surgery can be assured that outcomes are good as few lost independence. CGA/QOL highlight signs of vulnerability and options for pre-habilitation. Registries including a minimal CGA data set will make pre-selections reproducible and objectify risk/benefit estimations - relevant for those withheld from potentially curative surgery.