Page 180 - Risk quantification and modification in older patients with colorectal cancer

Chapter 9
if necessary or possible to optimise health status. Advanced care planning (post- treatment) could be discussed with the patient as well as patient’s expectations and priorities considering treatment options.
In general, the colorectal cancer treatment options were formulated before geriatric consultation; this could be the standard treatment according to guidelines or an adjusted treatment based on clinical judgement of the patient’s health status. Often, the cancer specialist suggested two options and asked the geriatrician’s input regarding which to choose. After the consultation, the geriatrician could subsequently agree with one of these options or recommend another alternative.
The geriatrician’s recommendations were discussed during MDT meetings or directly between the geriatrician and patient’s cancer specialist, after which a definitive treatment plan was formulated. Geriatric follow-up was initiated when indicated.
Data analysis
The primary outcome was to assess the effect of a geriatric evaluation on treatment decisions for older patients with colorectal cancer. Secondary analyses included the prevalence of geriatric impairments and the effect of geriatric evaluation on non-oncological interventions.
We collected the following data: age, sex, Charlson comorbidity index,7 medication use, tumour location (colon or rectum), tumour stage, treatment setting (palliative or curative) and suggested treatment (surgery (with/without (neo)adjuvant therapy), chemotherapy and/or radiotherapy, supportive care). Data from the geriatric evaluation included the presence of geriatric impairments, non-oncological interventions, suggestions regarding treatment choices and any additional yield of the consultation regarding advanced care planning, clarifying patient’s priorities and expectations regarding the treatment. Treatment decisions following geriatric consultation were classified as ‘more intensive treatment’ if the geriatrician recommended the treatment which is the more intensive of the suggested treatments (e.g. extensive surgery instead of (palliative) chemotherapy; normal-dose chemotherapy instead of low-dose chemotherapy or treatment). Suggestions were classified as ‘less intensive treatment’ if the less intensive treatment option was recommended by the geriatrician (e.g. low-dose chemotherapy instead
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