Page 73 - Risk quantification and modification in older patients with colorectal cancer

Geriatric risk score and poor surgical outcomes
Introduction
In Europe, colorectal cancer is the second most common cancer in women and the third most common in men.1 Colorectal cancer is an age-related disease; over 50% of all newly diagnosed patients are 70 years or older.2 Older patients represent a heterogeneous population due to differences in comorbidity, functional capacity and presence of geriatric impairments. These impairments can lead to decreased physiological reserves and diminished resistance to stressors and increase the risk of adverse outcomes of treatment.3 Not only do older patients have a four-fold higher risk of adverse postoperative outcomes4, but they are also more likely to experience a postoperative decline in physical function resulting in functional dependency and decreased quality of life.5
Geriatric assessment (GA) can be used to detect previous unaddressed problems in older patients. Information derived from GA can be used to discuss treatment options and improve functional status, and possibly survival.6 However prognostic information for patients with geriatric impairments is scarce, and currently available risk prediction tools for electively operated colorectal cancer patients do not include geriatric parameters.7-9 Therefore more prognostic information is required for the challenging process of shared decision making in older patients.
In The Netherlands for all older hospitalised patients over 70 years, standard care at admission includes a short evaluation of four important geriatric domains: risk for undernutrition, physical impairment, risk for delirium and fall risk, independently of whether GA is performed. This screening tool was implemented nationwide in 2012 as part of a National Patient Safety Program (VMS) after studying adverse events and potentially preventable deaths in Dutch hospitals and to direct geriatric interventions. Although VMS does not replace a GA, this easy-to-use and well- implemented geriatric tool could provide useful prognostic information, as it is also performed for all patients prior to elective surgery.
In this study we investigated whether a cumulative risk score composed of undernutrition, physical impairment, risk for delirium, and fall risk has prognostic value for survival and complications independently of age and American Society of Anesthesiologists (ASA) score in a large cohort of older electively operated colorectal cancer patients.
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