Page 63 - Risk quantification and modification in older patients with colorectal cancer

Risk stratification using ISAR-HP and G8 screening tools
risk for readmission after surgery and had a significantly longer length of hospital stay and an increased risk for six-month mortality. Combining the ISAR-HP with the G8 screening tool resulted in an even higher predictive value: patients being frail on both screening tools had 20% more complications, 19% more readmissions and 6-times increased odds for 30-day mortality. Moreover, they had 9-times increased odds for six-month mortality compared to non-frail patients. No association was observed between the G8 and outcome.
The ISAR-HP screening is an easy to use 4 question tool which can be performed by nurses. It was developed in the Netherlands to identify acutely hospitalised patients at risk for functional decline and readmission.15,16 In addition, a recent study showed that the ISAR-HP had moderate sensitivity (83%) and specificity (77%) for frailty in a population of older patients with end-stage renal disease.24 This is the first study of the ISAR-HP screening tool in colorectal cancer patients, and this study confirms its predictive value for readmission. Subgroup analysis showed that comorbidity alone did not predict mortality, which underlines the importance of other geriatric information.
The G8 was developed as a frailty screening tool for predicting the presence of impairments on a comprehensive geriatric assessment and was not intended to be a prognostic tool. Among all frailty screenings tools, G8 demonstrated the highest sensitivity for frailty.14 The lack of specificity of the G8 for frailty could explain the lack of association between a positive screening outcome and postoperative morbidity and mortality.
The prediction of adverse outcomes and identifying those patients at risk is important for several reasons. First, risk stratification helps clinicians to counsel their patients in the selection of the most appropriate treatment strategy and gives opportunities to discuss advanced care planning when treatment is withheld. Second, it yields opportunities for postoperative care planning, such as early- rehabilitation and/or fast-track surgery.25 In our hospital’s surgical strategies are currently not influenced by the result of the screening tools. However, patients identified as frail in the screening systems had a full geriatric intake to guide geriatric interventions and long term care needs and to initiate peri- and postoperative guidance.
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