Page 169 - Risk quantification and modification in older patients with colorectal cancer

Oncogeriatric care and Health Related Quality of Life
Discussion
In this study, we observed clinically relevant improvement in the majority of the HRQoL domains for functionally dependent patients with improvements in global health and a decrease in pain, fatigue, and gastrointestinal problems. For the functionally independent patients, global health remained stable with only clinically relevant improvement in weight loss. The expected negative impact of surgery on HRQoL in functionally dependent patients was not seen, despite the lower overall quality of life before surgery between functionally dependent and independent patients.
Only three earlier studies focused (partly) on functionally dependent36,37 or frail
patients with CRC.19 One study among a group of 86 older patients (mean age
70) undergoing CRC surgery reported that poorer physical functioning was
borderline associated (p=0.058) with lower quality of life both prior to surgery and
at 5-8 months follow-up.36 Another study reported an improvement in quality of
life (measured with the EuroQol-5D) in older patients with CRC or gastric cancer
(>75 years) 6 months after surgery. However, patients were not stratified based on
geriatric or functional dependency.37 Our study is in line with these studies and
also confirms the findings of a study that showed an improvement in HRQoL at
3 months follow-up in frail patients but no improvement at 12-28 months follow- up.19
In our study, 10% of the functionally independent patients and 12% of the functionally dependent patients had at least 1 point decrease in their Barthel Index after surgery (data not shown). These numbers are similar or even lower compared to other studies (7-31%).19,36,37 The reported decrease in physical function in these studies and our study are also lower than the studies included in an earlier review, where up to 60% decrease in perceived physical functioning was described.38 This discrepancy might be explained by improved CRC care in recent years: multiple efforts have been undertaken to improve surgical care, including improvement in peri-operative care (such as Enhanced Recovery After Surgery (ERAS)39 and laparoscopic surgery)40, better patient selection, and the introduction of geriatric- oncological additional care. These improvements in surgical care and the decrease in surgical complications and mortality in the past decade41 may have resulted in fewer patients with functional decline.
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