Page 139 - Risk quantification and modification in older patients with colorectal cancer

Prehabilitation in a multidisciplinary care program
Netherlands that dealt with all three aspects. Starting in 2012, a multidisciplinary Delphi round with multiple iterations was used to develop this multimodality approach which consisted of dedicated care, geriatric counselling, nutritional support, exercise training, laparoscopic surgery and early discharge to a rehabilitation facility when patients were not able to return home before day 6 after surgery (Appendix A).
In January 2014, this comprehensive multidisciplinary care program for colorectal cancer patients of 75 and older was implemented as standard practice. We hypothesised that this program could reduce mortality rates by half and also reduce complication rates.
In Europe and the Netherlands in particular, several prehabilitation and rehabilitation programs are currently initiated. However, there is a paucity of research in this field. To this day, we mostly rely on expert opinion on what elements to include in a pre- and rehabilitation program for elderly patients. This stresses the need for more clinical evidence.
This study aims to assess the usefulness of our multimodality care program for elderly CRC patients operated with curative intent. For comparison, we used two historic control cohorts of consecutive older patients operated in the same centre in the previous 4 years, before (2010-2011) and during (2012-2013) the development of the program. The primary endpoint of this study was 1-year overall mortality. Secondary endpoints were postoperative complication rates, readmission rates and 30-day mortality.
Patients and methods
Study population
All consecutive older patients aged 75 years who underwent surgical resection for CRC between 1 January 2010 and 31 December 2015 were included in our analysis. Patients from the first two years after the start of our comprehensive multidisciplinary care program (2014-2015) were compared to all consecutive older patients from before (2010-2011) and during (2012-2013) the development of our program. We choose historical cohorts from the same centre to minimalise
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