Page 158 - Risk quantification and modification in older patients with colorectal cancer

Chapter 8
Patients and methods
Population and setting
Data from Elder-1, a multicentre project designed to improve geriatric-oncological care for older patients with CRC, was used to perform this study. The Elder-1 was a longitudinal follow-up study on HRQoL and physical functioning, before and 3, 6 and 12 months after surgery. Furthermore, the project included a geriatric- oncological educational program and an online-tool for nurses. These were designed to identify frail patients and suggest early therapeutic interventions such as dietary support based on undernutrition screening and advising physiotherapy pre-and postoperatively for patients with recent falls or functional dependency. In addition, it was advised to identify polypharmacy, inadequate social support and perform cognitive and depression screening (Mini-Mental State Exam22 and geriatric depression scale23) with the advice of additional evaluation when indicated.
In participating hospitals, laparoscopic surgery was the preferred operating technique24 and peri- and postoperative care followed the Enhanced Recovery After Surgery (ERAS)25 guidelines.
From January 2014 to December 2015, patients were included from six Dutch hospitals. Ethical approval for this study was obtained from the Medical Ethics Committee Southwest Holland.
For the current study, all patients who were 70 years or older with elective surgery for CRC were included in the analysis. Exclusion criteria were carcinoma in situ, synchronous metastases or a synchronous other primary cancer or non-surgical treatment only.
Data collection
Before surgical treatment (T0), patients were asked to complete self-administered questionnaires about HRQoL and activities of daily living (ADL). Supplementary questions were added to these validated questionnaires to include social- demographic information such as marital status and current living situation (alone or with others).
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