Frailty Is an Independent Predictor of Survival in Older Patients With Colorectal Cancer

Abstract

Background. Colorectal cancer (CRC) is prevalent in the older population. Geriatric assessment (GA) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients. The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors (TNM) stage and age. Materials and Methods. A cohort of 178 CRC patients aged 70 and older were followed prospectively. All patients went through elective surgery, and GA was performed presurgery. The GA resulted in patients being divided into two groups: frail or nonfrail. All patients were followed for 5 years or until death. Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model.

Frailty and post-operative outcomes in older surgical patients: a systematic review

“…et al [26] a 176NorwayMean age 8057 % femaleProspective longitudinal studyCancer surgery(Elective)Balducci Frailty Criteria from CGAModified Fried criteria30 day mortalityAdjusted for cancer stage and ageBalducci OR 3.39 ( p  < 0.001)Modified Fried OR 2.67 ( p  = 0.029) Neuman, H.B. et al [37] a 12,979USAMean age 84.461.4 % femaleRetrospective analysis of Surveillance, Epidemiology and End Results(SEER)-Medicare databaseColectomy for stage I to III colon cancer(Elective)11 item frailty measure defined by the John Hopkins Adjusted Clinical Group case-mix system Difficulty walking, weight loss, frequent falls, malnutrition, impaired vision, decubitus ulcer, incontinence (plus 4 additional unnamed conditions) Frail ≥1/111) 90 day survival2) 1-year survivalAdjusted for covariates1) OR 10.4 ( p  < 0.001)2) OR 8.4 ( p  < 0.001) Ommundsen, N. et al [27] a 178NorwayMean age 8057 % femaleProspective cohort studyColorectal cancer surgery(Elective)Balducci Frailty Criteria from CGA5 year mortalityMultivariate adjusted for TNM stage and sexOR 3.6 ( p  < 0.001) Ronning, B. et al [28] b 84NorwayMedian age 8259 % femaleProspective cohort studyColorectal cancer surgery(Elective)Balducci Frailty Criteria from CGAPost-operative functional status1) Barthel Index ↓2) NEADL ↓3) TUG ↑4) Grip strength ↓Logistic regression (95 % CI)1) non-sig2) non-sig3) non-sig4) non-sig Tan, K-Y et al [29] b 83Singapore and JapanMean age 81.5 % female not reportedProspective cohort studyColorectal cancer(Elective)Fried criteriaPostop complications (Clavien-Dindo ≥ II)Bivariate analysisOR 4.08 ( p  = 0.006)General/abdominal Hewitt, J. et al [30] a 325UKMean age 77.657 % femaleProspective cohort studyGeneral surgical patients(Acute)- only 31 % underwent surgeryClinical Frailty Scale 7 frailty levels based on visual observation combined with an abbreviated review of medical records Frail is ≥51) 30 day mortality2) 90 day mortality3) LOS4) 30 day hospital readmissionAdjusted for age and polypharmacy, frail vs non frail1) non-sig2) non-sig3) 19 vs 7 days ( p  = 0.02)4) non-sig Kenig, J et al [31] a 184PolandMean age 76.953 % femaleProspective cohort studyAbdominal surgery(Acute)Vulnerable Elder Survey (VES) age, self-rated health, limitation in physical function and functional disabilities Triage Risk Screening Tool (TRST) cognitive impairment, difficulty walking/transferring/recent falls, ≥5 medications, ED use in previous 30 days or hospitalization in previous 90 day...…”

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table  1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

“…Overall, it is evident that elements from a GA predict both short-and long-term outcomes such as postoperative complications [14][15][16][17], length of stay [14], survival [18][19][20], and type of treatment received [18]. Furthermore, a composite measure such as frailty is a strong predictor of negative outcomes [14,19].…”

“…Two or more functional limitations were associated with overall mortality. In a prospective study of 182 patients aged 70 years and older undergoing elective CRC surgery, being frail was associated with an increased risk of postoperative complications and poor 5-year survival [14,19]. The domains of the GA that independently predicted poor outcomes were severe comorbidity, functional impairment, depression, and malnutrition [21].…”