Esteban T D Souwer1, Simone Oerlemans2, Lonneke V van de Poll-Franse3, Felice N van Erning2, Frederiek van den Bos4, Johan S Schuijtemaker5, Franchette W P J van den Berkmortel6, Daan Ten Bokkel Huinink7, Marije E Hamaker8, Jan Willem T Dekker9, Caroline A Wientjes10, Johanna E A Portielje11, Huub A A Maas12. 1. Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands,. Electronic address: e.souwer@hagaziekenhuis.nl. 2. Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands. 3. Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, the Netherlands; Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands. 4. Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands,; Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. 5. Department of Geriatric Medicine, Dijklander Ziekenhuis, Hoorn, the Netherlands. 6. Department of Internal Medicine, Zuyderland Medisch Centrum, Geleen-Heerlen, the Netherlands. 7. Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands. 8. Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands. 9. Department of Surgery, Reinier De Graaf Gasthuis, Delft, the Netherlands. 10. Department of Gastroenterology and Hepatology, OLVG, Amsterdam, the Netherlands. 11. Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands,; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands. 12. Department of Geriatric Medicine, Elisabeth-Tweesteden Ziekenhuis, Tilburg, the Netherlands.
Abstract
BACKGROUND: Older patients who are functionally compromised or frail may be at risk for loss of quality of life (QoL) after colorectal cancer (CRC) surgery. We prospectively studied health-related QoL (HRQoL) and its association with functional dependency on multiple time points before and after CRC surgery. METHODS: Included were patients aged 70 years and older who underwent elective CRC surgery between 2014 and 2015 in combination with an oncogeriatric care path. HRQoL (EORTC QLQ-C30 and CR38) and activities of daily living (ADL, Barthel Index) were measured at four time-points; prior to (T0) and at 3 (T3), 6 (T6), and 12 (T12) months after surgery. Functional dependency was defined as a Barthel Index <19. Using mixed-model regression analysis associations between dependency, time and HRQoL outcomes were tested and corrected for confounders. RESULTS: Response rate was 67% (n = 106) to two or more questionnaires; 26 (25%) patients were functionally dependent. Overall, functionally independent patients experienced a higher HRQoL than dependent patients. Compared to T0, significant and clinically relevant improvements in HRQoL after surgery were observed in functionally dependent patients: better role functioning, a higher global health, a higher summary score, less fatigue and less gastrointestinal problems (p < .05). In functional independent patients, we observed no clinically relevant change in HRQoL. CONCLUSION: Colorectal surgery embedded in geriatric-oncological care has a positive impact on HRQoL in older functionally dependent patients with cancer. Moderate functional dependency should not be considered a generic reason for withholding surgical treatment. Information derived from this study could be used in shared decision making.
BACKGROUND: Older patients who are functionally compromised or frail may be at risk for loss of quality of life (QoL) after colorectal cancer (CRC) surgery. We prospectively studied health-related QoL (HRQoL) and its association with functional dependency on multiple time points before and after CRC surgery. METHODS: Included were patients aged 70 years and older who underwent elective CRC surgery between 2014 and 2015 in combination with an oncogeriatric care path. HRQoL (EORTC QLQ-C30 and CR38) and activities of daily living (ADL, Barthel Index) were measured at four time-points; prior to (T0) and at 3 (T3), 6 (T6), and 12 (T12) months after surgery. Functional dependency was defined as a Barthel Index <19. Using mixed-model regression analysis associations between dependency, time and HRQoL outcomes were tested and corrected for confounders. RESULTS: Response rate was 67% (n = 106) to two or more questionnaires; 26 (25%) patients were functionally dependent. Overall, functionally independent patients experienced a higher HRQoL than dependent patients. Compared to T0, significant and clinically relevant improvements in HRQoL after surgery were observed in functionally dependent patients: better role functioning, a higher global health, a higher summary score, less fatigue and less gastrointestinal problems (p < .05). In functional independent patients, we observed no clinically relevant change in HRQoL. CONCLUSION: Colorectal surgery embedded in geriatric-oncological care has a positive impact on HRQoL in older functionally dependent patients with cancer. Moderate functional dependency should not be considered a generic reason for withholding surgical treatment. Information derived from this study could be used in shared decision making.