Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes

Mazzola, Michele; Bertoglio, Camillo Leonardo; Boniardi, Marco; Magistro, Carmelo; Martini, Paolo De; Carnevali, Pietro; Morini, Lorenzo; Ferrari, Giovanni

doi:10.1016/j.ejso.2017.06.006

Cited by 64 publications

(88 citation statements)

References 29 publications

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“…The health status of patients at risk for or with frailty should be optimized through preoperative physical, nutritional, and psychological optimization. Our intervention contributes to the nutritional prehabilitation, and our study provides the definition of the nurses' role within the inter-professional approach [57].…”

Section: Discussionmentioning

confidence: 99%

Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery

Noort¹,

Heinen²,

Asseldonk

et al. 2020

BMC Health Serv Res

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Section: Discussionmentioning

confidence: 99%

Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery

Noort¹,

Heinen²,

Asseldonk

et al. 2020

BMC Health Serv Res

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“…This enables physicians to deliver tailor-made care and pre-habilitation options for cancer treatment based on patients’ needs. Pro-active interventions aiming to optimize older patients’ frailty may be related with positive results for these patients[ 51 ]. In addition, since frailty was independently associated with QOL, it can be assumed that assessing frailty should be part of evaluations of the effectiveness of interventions based on patient-reported outcomes such as QOL.…”

Section: Discussionmentioning

confidence: 99%

Frailty and quality of life among older people with and without a cancer diagnosis: Findings from TOPICS-MDS

et al. 2017

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BackgroundThe number of older cancer patients is rising. Especially in older people, treatment considerations should balance the impact of disease and treatment on quality of life (QOL) and survival. How a cancer diagnosis in older people interacts with concomitant frailty to impact on QOL is largely unknown. We aimed to determine the association between frailty and QOL among community-dwelling older people aged 65 years or above with and without a cancer diagnosis cross-sectionally and at 12 months follow-up.MethodsData were derived from the TOPICS-MDS database. Frailty was quantified by a frailty index (FI). QOL was measured with the subjective Cantril’s Self Anchoring Ladder (CSAL, range: 0–10) and the health-related EuroQol-5D (EQ-5D, range:-0.33–1.00) at baseline and after 12 months. To determine associations, linear mixed models were used.Results7493 older people (78.6±6.4 years, 58.4% female) were included. Dealing with a cancer diagnosis (n = 751) was associated with worse QOL both at baseline (CSAL:-0.25 (95%-CI:-0.36;-0.14), EQ-5D:-0.03 (95%-CI:-0.05;-0.02)) and at follow-up (CSAL:-0.13 (95%-CI:-0.24;-0.02), EQ-5D:-0.02 (95%-CI:-0.03;-0.00)). A ten percent increase in frailty was also associated with a decrease in QOL at baseline (CSAL:-0.35 (95%-CI:-0.38;-0.32), EQ-5D:-0.12 (95%-CI:-0.12;-0.11)) and follow-up (CSAL:-0.27 (95%-CI:-0.30;-0.24), EQ-5D:-0.07 (95%-CI:-0.07;-0.06)). When mutually adjusting for frailty and a cancer diagnosis, associations between a cancer diagnosis and QOL only remained significant for CSAL at baseline (-0.14 (95%-CI:-0.25;-0.03)), whereas associations between frailty and QOL remained significant for all QOL outcomes at baseline and follow-up. No statistical interactions between cancer and frailty in their combined impact on QOL were found.ConclusionsCancer diagnosis and frailty were associated with worse health-related and self-perceived QOL both at baseline and at follow-up. Differences in QOL between older people with and without a cancer diagnosis were explained to a large extent by differences in frailty levels. This stresses the importance to take into account frailty in routine oncologic care.

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“…In a small single‐blind RCT, compared with usual care, a combination of home‐based moderate aerobic exercise with resistance training, nutritional counselling with protein supplementation and relaxation techniques commenced 4 weeks prior to colorectal cancer surgery, and continued for 8 weeks after, was associated with clinically meaningful changes (improved 6‐min walk test distance) in post‐operative functional capacity . Compared with usual care in a historical control group, preoperative treatment of malnutrition, smoking cessation and enhancement of respiratory and general fitness were associated with improved 30‐ and 90‐ day mortality and complication rates in frail older people undergoing upper gastrointestinal oncological surgery . In another non‐randomized study, patients (age ≥65 years; n = 189) undergoing elective abdominal surgery who received the modified Hospital Elder Life Program, a multicomponent nurse‐led intervention, were less likely to be frail on discharge compared with matched controls, but these effects dissipated at 3 months.…”

Section: Can Frailty Measurement Be Used To Identify a High‐risk Groumentioning

confidence: 99%

“…65 Compared with usual care in a historical control group, preoperative treatment of malnutrition, smoking cessation and enhancement of respiratory and general fitness were associated with improved 30-and 90-day mortality and complication rates in frail older people undergoing upper gastrointestinal oncological surgery. 66 In another non-randomized study, patients (age ≥65 years; n = 189) undergoing elective abdominal surgery who received the modified Hospital Elder Life Program, a multicomponent nurse-led intervention, were less likely to be frail on discharge compared with matched controls, 64 but these effects dissipated at 3 months. There is a lack of studies on comprehensive interventions in the preoperative phase of elective surgery that not only incorporate elements of exercise, nutritional support and behavioural techniques, but also have elements of assessment and medical optimization prior to surgerysuch as rationalization of pharmacology, treatment of anaemia and other biochemical/metabolic abnormalities, and fine-tuning of cardiorespiratory status.…”

Section: Evidence For Preoperative Optimizationmentioning

confidence: 99%

Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

Subramaniam

Tiruvoipati

Lodge

et al. 2020

ANZ Journal of Surgery

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Background The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post‐operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. Methods Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. Results We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. Conclusion Establishing multidisciplinary collaborative services to provide person‐centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large‐scale studies should focus on implementing and evaluating such multicomponent models of care.

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Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes

Cited by 64 publications

References 29 publications

Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery

Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery

Frailty and quality of life among older people with and without a cancer diagnosis: Findings from TOPICS-MDS

Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

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