Page 143 - Risk quantification and modification in older patients with colorectal cancer

Prehabilitation in a multidisciplinary care program
Results
Eighty-six patients were treated in 2014-2015 after implementation of the comprehensive multidisciplinary care program and were defined as our study cohort. The two control cohorts consisted of 63 patients in 2010-2011 and 75 patients in 2012-2014.
Baseline characteristics of patients in the three cohorts did not differ and are presented in Table 1. There was no significant difference in the distribution of patients with ASA score III or IV or patients with CCI score ≥2 (p=0.2) nor with congestive heart failure prior to surgery. The majority of patients had a tumour located in the colon. There was no difference in tumour stage (p=0.2). Preoperative geriatric evaluation was performed in 95% of patients in the study cohort, 34 patients (40%) had geriatric consultation. Nine patients (10%) were functional dependent with a KATZ score ≥2, seventeen patients (20%) reported falls within the past 6 months before surgery, 32 patients (37%) used a walking device, 18 patients (21%) reported cognitive impairment, 23 patients (27%) were at risk for malnutrition and in 40 patients (47%) polypharmacy was detected. Six patients (10%) in 2010-2011, seven patients (9%) in 2012-2013 and eleven patients (13%) in the study cohort received adjuvant chemotherapy (p=0.5).
Comprehensive multidisciplinary care program
Seventy-three out of the 86 patients (85%) followed the whole multimodality program or only the preoperative prehabilitation or postoperative rehabilitation part. Reasons for patients not to participate were: the patient was not interested (n=4), the patient was estimated fit (n=3), the patient was not informed (n=2). Four patients were not deemed eligible for the prehabilitation program because of an obstructing tumour (n=3) and M. Alzheimer (n=1).
Fifty-four patients (63%) patients followed the complete prehabilitation program, including prehabilitation at home or in an out-patient facility. One patient (1%) initially participated in the prehabilitation program but during the first three weeks developed bowel obstruction with subsequent non-elective surgery. A laparoscopic approach was used in 71 patients (83%). There was no difference in preoperative complications or surgical approach between the study and the control cohorts (Table 2).
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