Page 80 - Risk quantification and modification in older patients with colorectal cancer

Chapter 4
Analysis of the individual domains of the risk scores showed that Katz ADL score ≥2 (OR 3.5; 95% CI 1.6-7.3) and risk for delirium (OR 1.4; 95% CI 1.0-1.9) were independently associated with complications. Katz ADL ≥2 was also independently associated with discharge not to home (OR 2.9; 95% CI 1.4-6.3) and readmission (OR 2.9; 95% CI 1.4-6.3). Risk for delirium was independently associated with delirium (OR 2.1; 95% CI 1.4-3.1), discharge not to home (OR 1.8; 95% CI 1.3-2.6) and readmissions (OR 1.7; 95% CI 1.2-2.5). We found no associations between undernutrition or falls and any of the secondary outcomes.
Because undernutrition was not associated with survival or complications, we assessed these outcomes using a risk score where we omitted undernutrition. The results can be found in Appendix C. The HR for OS increased for score 1 (HR 2.5; 95% CI 1.4-4.6), 2 (HR 4.7; 95% CI 2.2-10.4) and 3 (HR 15.1; 95% CI 6.1-37.4). A score of 1 was associated with any complication (OR 1.8; 95% CI 1.2-2.9), the other scores were not. Mixed results were seen for the other outcomes.
Discussion
A risk sumscore that reflects the cumulative risk of four geriatric domains (delirium, undernutrition, falls and physical impairment) in older colorectal cancer patients was shown to be highly prognostic for mortality and morbidity after colorectal cancer surgery. In this study, patients with high risk sumscore had greatly increased hazard for mortality and complications independently of age and ASA score. Almost half of patients with high risk sumscore died within 3 years after surgery.
This study shows that this easy-to-use and well-implemented tool, which is aimed to direct geriatric care interventions, can also provide insight into individual risks of morbidity and mortality after colorectal cancer surgery in older patients and hence provide opportunities to discuss outcomes of treatment and shared decision making.
Two prior studies have been performed on the VMS geriatric domains. Heim et al. included more than 800 acute or electively hospitalised patients and showed that impairment in three or more domains was strongly associated with functional
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