Page 201 - Risk quantification and modification in older patients with colorectal cancer

thereby also determining age, gender and BMI specific cut-off points. Also, further standardisation of assessment methods and terminology could advance this field.8 For now, research should focus on these challenges and clinicians should rely on clinical measures such as physical functioning to provide prognostic information to older patients.
Health-related quality of life research
For older patients, retaining independence and health-related quality of life (HRQoL) are important outcomes of treatment and are ideally discussed when deciding upon cancer treatment.9,10 Although patients with mild to moderate functional dependency had a worse quality of life before CRC surgery, improvement in global health (QL), as well as on several functioning and symptom scales, were seen up to 6 months after surgery (Chapter 8). The observed improvement in quality of life after surgery could be related to the therapeutic effect of surgery or the effect of the oncogeriatric care they received. However, some older patients experience a persistent decrease in physical performance and lower HRQoL after CRC surgery. In our study cohort, this was around 10% of all patients (Chapter 8). Longitudinal QoL studies thus provide valuable information for patients and healthcare givers. Therefore future research in CRC could shift its focus from standard outcome measures such as complications and mortality to more patient- centred goals such as quality of life and postoperative physical functioning.
Standard measurement of pre- and postoperative physical functioning helps to determine which older patients lack resilience and do not recover to their preoperative level of functioning. In 256 older breast cancer patients receiving chemotherapy, 42% of patients experienced some form of functional decline; but almost 50% recovered after 12 months. Identifying the non-resilient patients and determining risk factors for non-resilience would be an advancement in the field of CRC care. This would also provide targets for interventions that could reduce the negative impact of CRC treatment for these patients.
Prehabilitation research
Improving a patient’s resilience before surgery using prehabilitation has gained interest in cancer surgery to improve outcomes and has been investigated in Chapter 7. At present, there is still no consensus on which elements to include in a prehabilitation program. Most prehabilitation programs included strength and
General discussion and future perspectives
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