Abstract
Objective
Older patients with cancer value functional outcomes as much as survival, but surgical
studies lack functional recovery (FR) data. The value of a standardized frailty assessment
has been confirmed, yet it's infrequently utilized due to time restrictions into everyday
practice. The multicenter GOSAFE study was designed to (1) evaluate the trajectory
of patients' quality of life (QoL) after cancer surgery (2) assess baseline frailty
indicators in unselected patients (3) clarify the most relevant tools in predicting
FR and clinical outcomes. This is a report of the study design and baseline patient
evaluations.
Materials & Methods
GOSAFE prospectively collected a baseline multidimensional evaluation before major
elective surgery in patients (≥70 years) from 26 international units. Short−/mid−/long-term
surgical outcomes were recorded with QoL and FR data.
Results
1003 patients were enrolled in a 26-month span. Complete baseline data were available
for 977(97.4%). Median age was 78 years (range 70–94); 52.8% males. 968(99%) lived
at home, 51.6% without caregiver. 54.4% had ≥ 3 medications, 5.9% none. Patients were
dependent (ADL < 5) in 7.9% of the cases. Frailty was either detected by G8 ≤ 14(68.4%),
fTRST ≥ 2(37.4%), TUG > 20 s (5.2%) or ASAIII-IV (48.8%). Major comorbidities (CACI
> 6) were detected in 36%; 20.9% of patients had cognitive impairment according to
Mini-Cog.
Conclusion
The GOSAFE showed that frailty is frequent in older patients undergoing cancer surgery.
QoL and FR, for the first time, are going to be primary outcomes of a real-life observational
study. The crucial role of frailty assessment is going to be addressed in the ability
to predict postoperative outcomes and to correlate with QoL and FR.
Abbreviations and Acronyms:
ADL (Activities of Daily Living), ASA (American Society of Anesthesiologists), CACI (Charlson Age Comorbidity Index), ECOG PS (Eastern Collaborative Oncology Group Performance Status), ERAS (Enhanced Recovery After Surgery), ESSO (European Society of Surgical Oncology), FR (Functional Recovery), fTRST (Flemish version of the Triage Risk Screening Test), G8 (Geriatric 8), MDT (Multidisciplinary Team), NRS (Nutritional Risk Screening), PROMs (Patient Reported Outcome Measures), QoL (Quality of Life), RCT (Randomized Control Trial), SIOG (International Society of Geriatric Oncology), TUG (Timed up and Go test), VAS (Visual Analogue Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Geriatric OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer and ageing: a nexus at several levels.Nat Rev Cancer. 2005; 5: 655-662https://doi.org/10.1038/nrc1675
- Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study.Lancet Oncol. 2014; 15: 23-34https://doi.org/10.1016/S1470-2045(13)70546-1
- Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service.Eur J Surg Oncol. 2019; https://doi.org/10.1016/j.ejso.2019.01.005
- Identifying older adults at risk of delirium following elective surgery: a systematic review and meta-analysis.J Gen Intern Med. 2018; https://doi.org/10.1007/s11606-017-4204-x
- Cause of death the first year after curative colorectal cancer surgery; a prolonged impact of the surgery in elderly colorectal cancer patients.Eur J Surg Oncol. 2014; https://doi.org/10.1016/j.ejso.2014.05.010
- Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study.Crit Rev Oncol Hematol. 2008; https://doi.org/10.1016/j.critrevonc.2007.11.001
- Screening for predictors of adverse outcome in onco-geriatric surgical patients: a multicenter prospective cohort study.Eur J Surg Oncol. 2015; 41: 844-851https://doi.org/10.1016/j.ejso.2015.02.018
- “Timed Up & Go”: a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study.PLoS One. 2014; 9https://doi.org/10.1371/journal.pone.0086863
- Understanding the treatment preferences of seriously ill patients.N Engl J Med. 2002; https://doi.org/10.1056/nejmsa012528
- Focus on surgical outcomes that matter to older patients.JAMA Surg. 2016; 151e161701https://doi.org/10.1001/jamasurg.2016.1701
- The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity.Clin Interv Aging. 2015; 10: 1131-1139https://doi.org/10.2147/CIA.S78698
- Under-representation of older adults in Cancer registration trials: known problem, little Progress.J Clin Oncol. 2012; https://doi.org/10.1200/jco.2012.41.6727
- Health Policy (New York). 1990; https://doi.org/10.1016/0168-8510(90)90421-9
- From translation to version management: a history and review of methods for the cultural adaptation of the euroqol five-dimensional questionnaire.Value Health. 2014; https://doi.org/10.1016/j.jval.2013.10.006
- Personalized management of elderly patients with rectal cancer: expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commissi.Eur J Surg Oncol. 2018; 44: 1685-1702https://doi.org/10.1016/j.ejso.2018.08.003
- Toxicity and response criteria of the eastern cooperative oncology group.Am J Clin Oncol. 1982 Dec; 5: 649-655
- Frailty and cancer:implications for oncology surgery, medical oncology, and radiation oncology.CA Cancer J Clin. 2017; https://doi.org/10.3322/caac.21406
Katz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv 2005. https://doi.org/10.2190/uurl-2ryu-wryd-ey3k.
- Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care.Arch Intern Med. 2008; https://doi.org/10.1001/archinte.168.18.2033
- Use of the Freund Clock Drawing Test within the Mini-Cog as a screening tool for cognitive impairment in elderly patients with or without cancer.J Geriatr Oncol. 2013; https://doi.org/10.1016/j.jgo.2012.10.175
- Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly.J Am Coll Surg. 2012; https://doi.org/10.1016/j.jamcollsurg.2012.02.007
- Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools.Aging Clin Exp Res. 2011; https://doi.org/10.1007/BF03325237
- A simple screening tool to predict outcomes in older adults undergoing emergency general surgery.J Am Geriatr Soc. 2019; 67: 309-316https://doi.org/10.1111/jgs.15627
- The timed “up & go”: a test of basic functional mobility for frail elderly persons.J Am Geriatr Soc. 1991; https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
- Measurement of gait speed in older adults to identify complications associated with frailty: a systematic review.J Geriatr Oncol. 2015; https://doi.org/10.1016/j.jgo.2015.08.006
- Screening older cancer patients: first evaluation of the G-8 geriatric screening tool.Ann Oncol. 2012; https://doi.org/10.1093/annonc/mdr587
- Ad hoc ESPEN working group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.Clin Nutr. 2003; 22: 321-336
- ASA physical status classifications: a study of consistency of ratings.Anesthesiology. 1978; https://doi.org/10.1097/00000542-197810000-00003
- Age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery.PLoS One. 2016 Feb 5; 11e0148076
- Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.Oncotarget. 2017; https://doi.org/10.18632/oncotarget.18401
- Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study.Med J Aust. 2010; 193: S62-S67
- Exploring the attitudes and behaviours of older people living with cancer.https://www.ipsos.com/ipsos-mori/en-uk/exploring-attitudes-and-behaviours-older-people-living-cancer([last time checked 4/13/19])Date: July 2015
- Use of comprehensive geriatric assessment in older cancer patients: Recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).Crit Rev Oncol Hematol. 2005; https://doi.org/10.1016/j.critrevonc.2005.06.003
- Major resections by cancer site, in England; 2006 to 2010. National Cancer Intelligence Network short report. Stage Breakdown by CCG 2014. London NCIN. 2016: 1-10 ([Accessed March 13, 2018])
- Prehabilitation and functional recovery for colorectal cancer patients.Eur J Surg Oncol. 2018; https://doi.org/10.1016/j.ejso.2018.04.016
- Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition).Eur J Surg Oncol. 2018; https://doi.org/10.1016/j.ejso.2017.12.010
- Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients – a multicentre cohort study.Eur J Surg Oncol. 2016; https://doi.org/10.1016/j.ejso.2016.03.005
OpenClinica open source software, version 3.1. Copyright © OpenClinica LLC and collaborators, Waltham, MA, USA, www.OpenClinica.com.
- Self-reported population health: An international perspective based on EQ-5D.2014 ([n.d])
- EuroQol–a new facility for the measurement of healthrelated quality of life.The EuroQol Group Heal Policy (Amsterdam, Metherlands). 1990; https://doi.org/10.1016/0168-8510(90)90421-9
- EuroQol: the current state of play.Health Policy (New York). 1996; https://doi.org/10.1016/0168-8510(96)00822-6
- (n.d.)https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/valuation/Date: 2019Date accessed: April 26, 2019
- EQ-5D as a quality of life measure in people with dementia and their carers: evidence and key issues.Value Health. 2011; https://doi.org/10.1016/j.jval.2010.08.002
- A single European currency for EQ-5D health states: Results from a six-country study.Eur J Health Econ. 2003; https://doi.org/10.1007/s10198-003-0182-5
- The american joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.Ann Surg Oncol. 2010; https://doi.org/10.1245/s10434-010-0985-4
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; https://doi.org/10.1097/01.sla.0000133083.54934.ae
Article info
Publication history
Published online: September 03, 2019
Accepted:
June 26,
2019
Received in revised form:
June 19,
2019
Received:
April 30,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
