Geriatric assessment and intervention in older vulnerable patients undergoing surgery for colorectal cancer: a protocol for a randomised controlled trial (GEPOC trial)

Abstract

Background The incidence of colorectal cancer (CRC) increases with age. Older patients are a heterogeneous group ranging from fit to frail with various comorbidities. Frail older patients with CRC are at increased risk of negative outcomes and functional decline after cancer surgery compared to younger and fit older patients. Maintenance of independence after treatment is rarely investigated in clinical trials despite older patients value it as high as survival. Comprehensive geriatric assessment (CGA) is an evaluation of an older persons’ medical, psychosocial, and functional capabilities to develop an overall plan for treatment and follow-up. The beneficial effect of CGA is well documented in the fields of medicine and orthopaedic surgery, but evidence is lacking in cancer surgery. We aim to investigate the effect of CGA on physical performance in older frail patients undergoing surgery for CRC. Methods GEPOC is a single centre randomised controlled trial including older patients (≥65 years) undergoing surgical resection for primary CRC. Frail patients (≤14/17 points using the G8 screening tool) will be randomised 1:1 to geriatric intervention and exercise (n = 50) or standard of care along (n = 50) with their standard surgical procedure. Intervention includes preoperative CGA, perioperative geriatric in-ward review and postoperative follow-up. All patients in the intervention group will participate in a pre- and postoperative resistance exercise programme (twice/week, 2 + 12 weeks). Primary endpoint is change in 30-s chair stand test. Assessment of primary endpoint will be performed by physiotherapists blinded to patient allocation. Secondary endpoints: changes in health related quality of life, physical strength and capacity (handgrip strength, gait speed and 6 min walking test), patient perceived quality of recovery, complications to surgery, body composition (Dual-energy X-ray absorptiometry and bioelectric impedance), serum biomarkers, readmission, length of stay and survival. Discussion This ongoing trial will provide valuable knowledge on whether preoperative CGA and postoperative geriatric follow-up and intervention including an exercise program can counteract physical decline and improve quality of life in frail CRC patients undergoing surgery. Trial registration Prospectively registered at Clinicaltrials.gov NCT03719573 (October 2018).

A Systematic Review and Meta-analysis on the Occurrence of Biomarker Mutation in Colorectal Cancer among the Asian Population

“…In this study, the age of the participants was also taken into consideration, the bulk of the recruited participants were adults, with most of them being over 50 years old, implying that KRAS gene mutation predominates in adult CRC. It was indeed as anticipated, given that older age has hitherto been identified as a health risk for CRC in numerous investigations [122]. Although data on gender were not reported for some studies in the included studies for this analysis, CRC was found to be more common in male patients (60.7%) than female patients (39.3%).…”

Relation between skeletal muscle volume and prognosis in rectal cancer patients undergoing neoadjuvant therapy

“…Several other authors tried to identify patients’ characteristics or tumor factors that could be associated with sarcopenia. As expected, a relationship with older age was found since cancer and aging recognize a similar pathophysiologic mechanism[ 40 ]. In patients with colorectal cancer, sarcopenia was associated with body mass index (BMI), serum carcinoembryonic antigen level and mean number of metastatic lymph nodes[ 10 ] while in patients with colorectal liver metastasis with female sex, low BMI and a lower amount of intra-abdominal fat[ 41 ].…”

A nationwide web-based survey of oncologic surgeons to clarify the current status of preoperative assessment for elderly cancer surgery patients in Japan

“…The results showed that interventions based on preoperative GA did not reduce the incidence of grade II-IV adverse events 15 . Currently, there are several randomized controlled trials evaluating the usefulness of preoperative GA for elderly cancer surgery patients, and the results are promising 16 , 17 . However, differences in the background of the study population, selection bias, surgical techniques and assessment tools used, as well as endpoints, make it difficult to build evidence, and this is an issue that should be investigated in the future.…”