How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center
<b>Objective:</b>Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer (CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
China Anti-Cancer Association
2015-12-01
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| Series: | Cancer Biology & Medicine |
| Subjects: | |
| Online Access: | http://www.cancerbiomed.org/index.php/cocr/article/view/884 |
| _version_ | 1830286968656756736 |
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| author | Giampaolo Ugolini Francesco Pasini Federico Ghignone Davide Zattoni Maria Letizia Bacchi Reggiani Daniele Parlanti Isacco Montroni |
| author_facet | Giampaolo Ugolini Francesco Pasini Federico Ghignone Davide Zattoni Maria Letizia Bacchi Reggiani Daniele Parlanti Isacco Montroni |
| author_sort | Giampaolo Ugolini |
| collection | DOAJ |
| description | <b>Objective:</b>Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer (CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over-or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.<br/><b>Methods:</b>Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.<br/><b>Results:</b>Forty-six patients were studied. The median follow-up time after surgery was 4.6 years (range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived (4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go (TUG), Eastern Cooperative Group Performance Status (ECOG PS), Instrumental Activities of Daily Living (IADLs), Vulnerable Elders Survey (VES-13) scoring systems were significantly associated with increased long term mortality risk.<br/><b>Conclusion:</b>Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients. |
| first_indexed | 2024-12-19T04:07:59Z |
| format | Article |
| id | doaj.art-307ef6d3cdb84a94b97d6a67f7959abb |
| institution | Directory Open Access Journal |
| issn | 2095-3941 2095-3941 |
| language | English |
| last_indexed | 2024-12-19T04:07:59Z |
| publishDate | 2015-12-01 |
| publisher | China Anti-Cancer Association |
| record_format | Article |
| series | Cancer Biology & Medicine |
| spelling | doaj.art-307ef6d3cdb84a94b97d6a67f7959abb2022-12-21T20:36:28ZengChina Anti-Cancer AssociationCancer Biology & Medicine2095-39412095-39412015-12-0112430230710.7497/j.issn.2095-3941.2015.00842015000084How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical centerGiampaolo Ugolini0Francesco Pasini1Federico Ghignone2Davide Zattoni3Maria Letizia Bacchi Reggiani4Daniele Parlanti5Isacco Montroni6Department of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital, Bologna 40138, Italy<b>Objective:</b>Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer (CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over-or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.<br/><b>Methods:</b>Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.<br/><b>Results:</b>Forty-six patients were studied. The median follow-up time after surgery was 4.6 years (range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived (4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go (TUG), Eastern Cooperative Group Performance Status (ECOG PS), Instrumental Activities of Daily Living (IADLs), Vulnerable Elders Survey (VES-13) scoring systems were significantly associated with increased long term mortality risk.<br/><b>Conclusion:</b>Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.http://www.cancerbiomed.org/index.php/cocr/article/view/884Elderlygeriatric assessmentsurgical oncologyrisk assessmentscreening toolscolorectal cancer (CRC) |
| spellingShingle | Giampaolo Ugolini Francesco Pasini Federico Ghignone Davide Zattoni Maria Letizia Bacchi Reggiani Daniele Parlanti Isacco Montroni How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center Cancer Biology & Medicine Elderly geriatric assessment surgical oncology risk assessment screening tools colorectal cancer (CRC) |
| title | How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center |
| title_full | How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center |
| title_fullStr | How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center |
| title_full_unstemmed | How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center |
| title_short | How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center |
| title_sort | how to select elderly colorectal cancer patients for surgery a pilot study in an italian academic medical center |
| topic | Elderly geriatric assessment surgical oncology risk assessment screening tools colorectal cancer (CRC) |
| url | http://www.cancerbiomed.org/index.php/cocr/article/view/884 |
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