Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers

Abstract

Objective: To establish reliable standards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living (ADL) and quality of life (QOL). Summary Background Data: ADL and QOL are important outcomes of surgery for the elderly. However, there has been only limited evidence on the natural course of recovery of functional independence. Methods: Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospectively examined. Physical conditions, ADL, and QOL were evaluated preoperatively and at the first, third, and sixth postoperative month. Results: The mortality and morbidity rates were 0.4% and 28%, respectively. Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively, but most patients recovered from this transient reduction, with only 3% showing a decline at the sixth postoperative month (6POM). ADL of these patients was likely to decrease after discharge from the hospital. QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores. Conclusions: Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer, only a few showed a protracted decline in ADL and most exhibited better QOL after surgery. This indicates that surgical treatment should be considered, whenever needed, for elderly patients 75 years old or older with gastric or colorectal cancer. Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients. (Ann Surg 2007;246: 222-228)

Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? a large‐scale Korean multi‐center study

“…The prognosis of patients with EGC after curative surgery is highly favorable with reported 5-year survival rates in the excess of 90% [3], therefore, the quality of lives of these patients has greatly been emphasized [4]. Considering the quality of life (QOF), endoscopic mucosal resection/r endoscopic submucosal dissection (EMR/ESD) is now widely accepted for mucosal gastric cancers without lymph node metastasis [5,6].…”

Disability and Quality of Life after Surgery for Cancer

“…The surgical risk predictive scales such as POSSUM and E-PASS were the associated risk factors. 3 We observed a disability rate of 17%. These differences with our results appear to derive from differences in the composition of the studied participants.…”

“…Postoperative complications are associated with an ADL declined. 3 We found that disability was related with impairment in HRQoL. Consequently, postoperative complications, through the limitations for ADL, could explain its negative effect on HRQoL.…”

“…Thus disability has been assessed in several studies of cancer patients. 3,8 Recently, Khoei et al 32 proved that the Katz index is a reliable instrument for oncologic patients using the Physical Function subscale of SF 36 as criterion of validity (Cronbach's alpha 0.923).…”

“…Severe impairment in HRQoL was defined as≤50 points in VAS. Both the modified Katz index 3,[17][18][19][20][21] and EuroQoL-5D-3L [22][23][24][25][26][27][28][29][30] has been widely used in different clinical setting, including surgical cancer patients. …”