Page 140 - Risk quantification and modification in older patients with colorectal cancer

Chapter 7
demographic as well as institutional variation. To minimise the risk for confounding by indication, we excluded patients with stage IV disease, synchronous cancer at the time of diagnosis, or non-elective surgery from all three cohorts from our analysis.
Comprehensive multidisciplinary care program
From January 1st 2014 onwards, patients aged 75 years and older, referred for elective colorectal surgery to the department of colorectal surgery at Reinier de Graaf Hospital, were informed about our multidisciplinary care program.
Our team consisted of dedicated health-care professionals focused on improving care for elderly patients. All surgeons were experienced colorectal surgeons with more than 200 laparoscopic colorectal resections performed per surgeon before the start of this program.
A more detailed overview of our program is shown in Appendix A. In short, a preoperative assessment of patients was done by the treating surgeon and dedicated nurses, which also included geriatric screening14,15 and a subsequent geriatric assessment when indicated. Patinets with cardiac or pulmonary comorbidity were referred for cardiopulmonary optimisation prior to surgery. All patients were referred to a dietician for a full nutritional assessment,16 with subsequent nutrition support with a targeted intake of protein of 1.2-1.5grams/kg/day.17,18 A Short Nutritional Assessment Questionnaire (SNAQ) questionnaire (cut-off ≥2)19 was performed for all patients.
As part of standard care, a surgical oncology nurse practitioner was assigned as case manager that ensured meeting patients individual needs. This also included cognitive and emotional guidance, both pre- and post-operatively, with referral to more specialised care when needed.20 Radiological workup was according to the Dutch national guidelines on CRC21 and all patients were discussed in a multidisciplinary oncology team (MDT).
Timing of surgery was at least 6 weeks after diagnosis to allow preoperative physical training. The training program consisted of resistance training as well as endurance training and two sessions a week were intended for 4-6 weeks. All training sessions were supervised by a local physiotherapist, and each session was
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