Page 157 - Risk quantification and modification in older patients with colorectal cancer

Oncogeriatric care and Health Related Quality of Life
Introduction
In 2016, > 15,000 patients were diagnosed with colorectal cancer (CRC) in the Netherlands, and > 50% of these patients were aged 70 years or older.1 For most patients, surgical resection is the treatment of choice.2 However, with increasing age, older patients are at increased risk for adverse outcomes of treatment such as complications, readmission or death.3-5 The risk of adverse outcomes of surgery is influenced by comorbidity, impaired physical functioning and cognitive impairments, all more prevalent among older patients with CRC.6-8
Besides classical endpoints of oncological trials such as survival and complication rates9, functional, social and emotional issues have high priorities to older patients10 Health-related quality of life (HRQoL) and retaining independence are therefore relevant outcomes in older patients with cancer11 and are ideally discussed in addition to survival and complications when decisions are made about cancer treatment.
Complications12-14 as well as receiving chemotherapy and older age itself15,16 are associated with lower HRQoL after surgery. Still, HRQoL is expected to differ among older patients especially in patients with functional dependency, knowing that functional dependency is related to frailty and is also an important determinant for adverse outcomes of surgery.17 Therefore, preoperative and postoperative HRQoL outcome information with stratification based on functional dependency is likely to be useful for shared decision making. In this process, HRQoL outcome information should also include a longer postoperative follow-up, as the impact of surgery for older patients extends to the first postoperative year.18 Based on earlier literature we would still expect a negative impact of CRC surgery on HRQoL in functionally dependent patients. Studies that investigated the impact of surgery on HRQoL and physical functioning are limited or showed mixed results.19-21 In the majority of these studies, important information on preoperative functioning and baseline HRQoL was lacking.
This study aims to investigate HRQoL at multiple time points before and after colorectal surgery and the association with functional dependency, time and HRQoL in older patients with CRC in the first year after surgery.
155
8