Page 195 - Risk quantification and modification in older patients with colorectal cancer

regression analysis method. Internal validation contributed to the reliability of the model, but external validation including assessment of calibration is warranted before further use of this model to guide preoperative counselling and possible allocation of interventions.
Part II. Risk modification
In Chapter 7, we have shown that it was feasible to implement a prehabilitation and rehabilitation program for patients aged 75 years and older and that such a program may contribute to lower complications and reduces length of hospital stay. No clear benefit was shown for other postoperative outcomes. Dedicated multidisciplinary care seems the key attributor to favorable outcomes of CRC surgery in elderly patients.
The topic of Chapter 8 has been Health-Related Quality of Life (HRQoL) and functional dependency after CRC surgery among patients treated in an oncogeriatric care setting. A longitudinal follow-up study was designed for older CRC patients, with baseline and follow-up questionnaires (at 3, 6 and 12 months). Older patients with mild to moderate functional dependency (Barthel Index < 19) were shown to have a lower baseline quality of life compared to functionally independent patients before surgery including more symptoms (fatigue and pain) and lower perceived global health. During 1-year of follow-up, mean scores on the function and symptom scores improved in functionally dependent patients and remained at the preoperative level for functionally independent patients. Therefore, CRC surgery embedded in a geriatric-oncological care model may have a positive impact on HRQoL in older functionally dependent cancer patients.
Chapter 9 addresses the effect of a Comprehensive Geriatric Assessment (CGA) on treatment decisions. Older patients with stage I-IV CRC referred for geriatric consultation between 2013-2015 were included. In 93% of patients, one or more geriatric impairments were found. A “more intensive treatment” option was recommended in 69% of patients and in 31% a “less intensive treatment” option. CGA can lead to changes in the treatment plan for individual cases, also in older CRC patients.
Summary
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