Page 184 - Risk quantification and modification in older patients with colorectal cancer

Chapter 9
oncological interventions that followed after geriatric consultation were mostly aimed at malnutrition, social network, psychological and cognitive disorders.
The number of older colorectal cancer patients has increased in recent years en is expected to rise even further in decades to come.8 These patients often present with co-existing health issues and functional or cognitive decline.9 Especially in these frail patients, colorectal surgery comes with high morbidity-rates.1 Moreover, survival is greatly affected by the outcome of surgery, mainly in the first postoperative year.2 Therefore, optimal decision making is of the utmost priority for this heterogeneous patient group. Our study shows, similar to other studies,10,11 that a geriatric consultation can be helpful in this challenging task.
Untreated colorectal cancer can lead to serious cancer-related complications. One could decide to choose for ‘less intensive treatment’ which does not always mean that there will be no treatment. For example, instead of an extensive surgical colorectal resection, one could perform minimal surgery only such as the placement of an (diverting) ostomy to palliate obstruction complaints. Elderly do not experience more limitations or psychosocial impact due to this ostomy compared to younger ostomy carriers.12 In such cases, these ‘less intensive treatment’ options may prevent the high postoperative complication rates (reported in up to 41%) and postoperative 30-day mortality rates of 10% in patients ≥85 years old undergoing colorectal cancer resection.1 This might be an option in some individual cases for whom ‘the more intensive treatment’ is not desirable. Another way to reduce the treatment intensity, is by offering a patient monotherapy instead of combination chemotherapy. The expected oncologic effect might not be as good as in normal (protocolised) dose chemotherapy, but one can expect treatment-related toxicity to be less pronounced.13,14
Similar to what we have seen in our cohort, previous research has shown that the geriatric consultations can result in non-oncologic interventions in up to 70% of patients.15 These interventions are aimed at improving patient’s health status before treatment, which could be particularly pertinent because patients with comorbidity are more prone to develop post-treatment morbidity or mortality1,16 The effectiveness of these interventions is still not very clear. A recent study that enrolled 60 cancer patients aged 70 years or older showed that geriatric assessment guided multidisciplinary interventions increased quality of life and
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