Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Abstract

Background and Objectives: We assessed frailty, measured by a comprehensive geriatric assessment-based frailty index (FI-CGA), and its association with postoperative outcomes among older thoracic surgical patients.Methods: Patients aged ≥65 years evaluated in the geriatric-thoracic clinic between June 2016 through May 2020 who underwent lung surgery were included. Frailty was defined as FI-CGA > 0.2, and "occult frailty", a level not often recognized by surgical teams, as 0.2 < FI-CGA < 0.4. A qualitative analysis of geriatric interventions was performed.Results: Seventy-three patients were included, of which 45 (62%) were nonfrail and 28 (38%) were frail. "Occult frailty" was present in 23/28 (82%). Sixty-one (84%) had lung malignancy. Geriatric interventions included delirium management, geriatricspecific pain and bowel regimens, and frailty optimization. More sublobar resections versus lobectomies (61% vs. 25%) were performed among frail patients. Frailty was not significantly associated with overall complications (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 0.88-6.44; p = 0.087), major complications (OR: 2.33; 95% CI: 0.48-12.69; p = 0.293), discharge disposition (OR: 2.8; 95% CI: 0.71-11.95; p = 0.141), or longer hospital stay (1.3 more days; p = 0.18). Conclusion:Frailty and "occult frailty" are prevalent in patients undergoing lung surgery. However, with integrated geriatric management, these patients can safely undergo surgery.

Progression of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries

“…10,35–38 As a corollary to this, there have been strategies such as pre-rehabilitation, entailing physical therapy with a goal of improving one’s functional status prior to a procedure, and geriatric co-management, that have been suggested to attenuate the effect of frailty on risk. 21,22,39,40 While the impact of pre-rehabilitation efforts has been mixed, intrinsic to this premise is the notion that frailty is at least partially mutable. 22,41…”

How frail is frail in oncology studies? A scoping review

“…Fifteen studies were speci cally conducted in the medical oncology setting, 19,20,23,24,[26][27][28][29][33][34][35]38,43,51,54 eight studies in surgical oncology, 41,42,45,49,52,53,55,56 and the remainder were either mixed or not speci ed. 17,18,22,25,[30][31][32]36,37,39,40,44,[46][47][48]50,57,58 Fourteen studies included a range of cancers and the rest focused on individual cancer types.…”

“…20,[22][23][24][25]30,32,36,39,40,44,46,47,50,57,58 There were 10 studies of breast cancer, [17][18][19][26][27][28][29]33,37,56 of which six studies were different secondary analyses of the same prospective clinical trial. 19,26,27,33 Similarly, two 34,51 of the ve lung cancer studies utilised the same retrospective database, 34,35,48,49,51 as did three [53][54][55] of four studies of gynaecological cancers, 45,[53][54][55] and both studies of pancreatic cancer. 30,31 Four studies evaluated gastrointestinal cancers, 23,38,41,42 and one was speci cally evaluated participants with meningiomas.…”

“…39 Four of these studies de ned categories of increasing frailty, most often with 0.1 increments in FI. [47][48][49][50] References for these studies varied, including work by Rockwood and colleagues 59,60 One group de ned the optimum FI cut-off point for predicting adverse outcomes in women with advanced ovarian cancer. [53][54][55] An FI = 0.15 was the cut-off that yielded the highest Youden's index for their three binary outcomes (Accordion Grade 3 or 4 complication, 90-day mortality, receipt of chemotherapy within 42 days), while yielding the highest separation in outcome rates between frail and non-frail.…”

Chirurgie des alten Menschen – Thoraxchirurgie

“…In der Transplantationschirurgie wird derzeit versucht, die besonders gebrechlichen Kandidaten, das biologische Alter und die immunologische Kompetenz anhand von Bildgebungen, blutbasierten Biomarkern, Zellfunktion, Entzündung und Telomerlänge besser zu eruieren [ 46 ]. Mehrere geriatrische Fragebögen und Bewertungsskalen wurden inzwischen auch auf Prädiktion des postoperativen Verlaufs alter gebrechlicher PatientInnen getestet [ 54 , 55 ]. Unter ihnen hat sich aber noch keiner/keine durchgesetzt.…”