Page 179 - Risk quantification and modification in older patients with colorectal cancer

Introduction
Treating elderly colorectal cancer patients can be challenging. These patients have higher rates of post-treatment morbidity and (excess) mortality.1,2 In addition, they are also at risk for functional decline after treatment, with reported rates of more than 60% in the elderly.3 Therefore, it is very important to carefully weigh the risks and benefits of potential treatments. Given the heterogeneity within the older adult population, age itself is not a useful selection tool for oncologic treatment, and patients should be managed according to their individual health status.4 Recent research has focused on using geriatric assessments to provide a more comprehensive overview of an older patient’s overall health status across multiple domains such as physical, psychosocial and functional status.5,6
This study aimed to assess the relevance of geriatric consultations (including a comprehensive geriatric assessment) in decision making for older patients with colorectal cancer and to assess if it leads to an altered treatment of these patients.
Patients and methods
This study was performed at three teaching hospitals in the Netherlands. Patients were included between 2013 and 2015 from the Diakonessenhuis Hospital in Utrecht, the Hagaziekenhuis in The Hague and the Elisabeth-Tweesteden Hospital in Tilburg. Consecutive colorectal cancer patients who were referred for a geriatric consultation were included. Patients were selected for geriatric consultation by the referring physician (surgeon, medical oncologist, gastroenterologist) or within a multidisciplinary oncology team (MDT) meeting to obtain a recommendation regarding the treatment or for optimisation of patient’s health prior to the treatment. Patients were seen by a geriatrician in the outpatient clinic or during hospital stay.
The geriatric consultations were performed by three geriatricians trained in geriatric oncology (MH, HM and FB). These assessments consisted of an evaluation of the patient’s medical history, polypharmacy (the use of ≥5 medications), cognitive impairments, mood disorders, nutritional status, physical impairments, social network and care needs. Interventions for each of these domains were initiated
CGA and treatment decisions
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