Page 64 - Risk quantification and modification in older patients with colorectal cancer

Chapter 3
This study has some limitations. First, only 61% of all elective surgical colorectal cancer patients received a geriatric screening. Comparison of baseline characteristics yielded no indication of selection bias, but the risk of confounding by indication may exist. Second, unfortunately, we do not have data on functional outcomes, which especially in an older population, are important outcomes after cancer treatment. Third, older patients with non-elective, acute colorectal surgery had no frailty screening and hence could not be included in the study, while risk stratification, preoperative optimisation and advanced care planning may be especially important for this category of patients.26 Moreover, the number of primary events was too low to perform multivariable analysis to correct for standard confounders or assess the impact of (neo)adjuvant therapy on outcomes. As this was a cohort analysis of available data, we did not perform an official sample size calculation.
Despite these limitations, one may use ISAR-HP with or without G8 to gain insight into the risk for adverse outcomes, thereby providing valuable information for shared decision making. It can also be used to adjust treatment plans in this heterogeneous group of patients.
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