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Isngadi I, Asmoro AA, Huda N, Siswagama TA, Rehatta NM, Chandra S, Sari D, Lestari MI, Senapathi TGA, Nurdin H, Wirabuana B, Pramodana B, Pradhana AP, Anggraeni N, Sikumbang KM, Halimi RA, Jasa ZK, Nasution AH, Mochamat M, Purwoko P. Preoperative Geriatric Characteristics Associated with Changes in Postoperative Cognitive Function and Quality of Life: A Prospective Observational Analytic Multicenter Study. Ann Geriatr Med Res 2025; 29:28-37. [PMID: 39262332 PMCID: PMC12010739 DOI: 10.4235/agmr.24.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/02/2024] [Accepted: 08/15/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Changes in cognitive function are associated with increased depression and decreased quality of life (QOL). This study aimed to determine the relationship between the characteristics of geriatric patients and anesthetic management with changes in postoperative cognitive function and QOL of geriatric patients undergoing elective surgery. METHODS This prospective observational analytic multicenter study included patients aged ≥60 years who underwent elective surgery in hospitals in Indonesia. We used the whole sampling method and performed follow-up 30 days after surgery. Data were analyzed using bivariate chi-square and multivariate regression tests with a confidence interval of 95% and α=5%. RESULTS Among the 933 geriatric patients included in this study 55.0%, females most (59.8%) received general anesthesia. Factors including age (p<0.001, B=-0.374, odds ratio [OR]=0.688), body mass index (BMI) (p<0.05, B=0.129, OR=1.138), and physical status based on American Society of Anesthesiologists (ASA) classification (p<0.001, B=-0.458, OR=0.633) were significantly associated with postoperative cognitive function. BMI (p<0.001, B=-0.218, OR=1.244), absence of comorbidities (p<0.05, B=-0.312, OR=0.732), regional anesthesia (p<0.05, B=0.606, OR=1.883), and changes in cognitive function (p<0.05, B=0.288, OR=1.334) were significantly correlated with changes in postoperative QOL. CONCLUSION Age, BMI, and ASA physical status were significantly associated with postoperative cognitive function in geriatric patients, whereas BMI, comorbidities, regional anesthesia, and changes in postoperative cognitive function were associated with QOL. These preoperative factors can predict postoperative cognitive function and QOL and may be useful during preoperative planning.
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Affiliation(s)
- Isngadi Isngadi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University–Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Aswoco A. Asmoro
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University–Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Nurul Huda
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University–Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Taufiq A. Siswagama
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University–Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Nancy M. Rehatta
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University–Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Susilo Chandra
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Indonesia–Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Djayanti Sari
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University–Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mayang I. Lestari
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Sriwijaya University–Dr. Mohammed Hoesin General Hospital, Palembang, Indonesia
| | - Tjokorda G. A. Senapathi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Udayana University–Sanglah General Hospital, Denpasar, Indonesia
| | - Haizah Nurdin
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University–Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Belindo Wirabuana
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University–Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Bintang Pramodana
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Indonesia–Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Adinda P Pradhana
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Udayana University–Sanglah General Hospital, Denpasar, Indonesia
| | - Novita Anggraeni
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Riau University–Arifin Achmad General Hospital, Riau, Indonesia
| | - Kenanga M. Sikumbang
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Lambung Mangkurat University–Ulin General Hospital, Banjarmasin, Indonesia
| | - Radian A. Halimi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Padjadjaran University–Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Zafrullah K. Jasa
- Anesthesiology and Intensive Therapy Department, Faculty of Medicine, Syiah Kuala University/ Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Akhyar H. Nasution
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sumatera Utara–Dr. Adam Malik General Hospital, Medan, Indonesia
| | - Mochamat Mochamat
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Diponegoro University–Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Purwoko Purwoko
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Sebelas Maret University-Dr. Moewardi General Hospital, Surakarta, Indonesia
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Pang NQ, Lau J, Tan KK. Health-Related Quality of Life After Colorectal Cancer Surgery in Older Patients Compared to the Young: A Prospective Multicentre Observational Study. J Appl Gerontol 2025:7334648251321560. [PMID: 39993183 DOI: 10.1177/07334648251321560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025] Open
Abstract
Introduction: The impact of colorectal surgery on older adults' (≥65 years) health-related quality of life (HRQoL) is rarely reported. Methods: This prospective multi-institutional cohort study involving 217 participants investigated factors affecting older colorectal cancer (CRC) patients' HRQoL following surgery with the EORTC QLQ-C30 and the HADS. Results: The trend of the global QoL and individual subscales show an overall dip in QoL from baseline to pre-discharge, before slowly rising until the 6-month mark. Baseline score of individual outcome measures was the only constant predictor of the outcome measure over time. Conclusion: Age was not found to be a significant predictor of HRQoL in older adults undergoing colorectal surgery, while baseline scores of individual outcome measures consistently predicted post-operative HRQoL scores. Interventions should be targeted at specific subgroups of older adults scheduled for colorectal surgery, such as those with lower baseline scores.
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Affiliation(s)
- Ning Qi Pang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, Singapore
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore
| | - Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ker-Kan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, National University Health System, Singapore
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Roo ACD, Ivatury SJ. Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery. Clin Colon Rectal Surg 2025; 38:64-73. [PMID: 39734716 PMCID: PMC11679189 DOI: 10.1055/s-0044-1786392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2024]
Abstract
Adults ≥ 65 years of age comprise nearly 20% of the U.S. population and over half of surgical patients. Older adults, particularly when frail, may require additional preoperative evaluation and counseling, specialized hospital care, and may experience more noticeable physical and cognitive changes than younger or healthier patients. Surgeons can assess frailty and risk using several frailty measures, as data exist demonstrating worse perioperative outcomes among patients undergoing colorectal surgery. Prehabilitation programs have not been shown to improve surgical outcomes for colorectal surgery patients but may help maintain physical function or hasten recovery to baseline around the time of surgery, particularly for frail patients. Functional decline and delirium are common postoperatively in older adult patients, particularly those who are frail at baseline, and should be discussed with at-risk older adults. Primary care physicians and geriatricians can help with in-depth evaluation of frailty and geriatric syndromes. Special attention to the risks, outcomes, and care of older adults considering or undergoing colorectal surgery can help inform decision-making, which may facilitate goal-concordant care.
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Affiliation(s)
- Ana C. De Roo
- Division of Colorectal Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Srinivas J. Ivatury
- Division of Colon and Rectal Surgery, Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
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Ramírez-Giraldo C, Avendaño-Morales V, Van-Londoño I, Melo-Leal D, Camargo-Areyanes MI, Venegas-Sanabria LC, Vargas JPV, Aguirre-Salamanca EJ, Isaza-Restrepo A. Lymph Node Dissection of Choice in Older Adult Patients with Gastric Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:7678. [PMID: 39768601 PMCID: PMC11678213 DOI: 10.3390/jcm13247678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 01/11/2025] Open
Abstract
Background: Although the current literature has shown an increasing interest in surgical treatment of gastric cancer (GC) in older adults in recent years, there is still no consensus on proper management in this subgroup of patients. This study was designed with the objective of evaluating the current evidence that compares limited lymph node dissection with extended lymph node dissection in older adult patients (≥65 years) coursing with resectable GC. Methods: A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. All studies before 2018 were selected using a systematic review by Mogal et al. Studies were eligible for this meta-analysis if they were randomized controlled trials or non-randomized comparative studies comparing limited lymph node dissection versus extended lymph node dissection in patients with resectable GC taken to gastrectomy. Results: Seventeen studies and a total of 5056 patients were included. There were not any statistically significant differences in OS (HR = 1.04, CI95% = 0.72-1.51), RFS (HR = 0.92, CI95% = 0.62-1.38), or CSS (HR = 1.24, CI95% = 0.74-2.10) between older adult patients taken to limited and extended lymphadenectomy in addition to gastrectomy as the current surgical treatment for GC. Although a higher rate of major complications was observed in the extended lymphadenectomy group, this difference was not statistically significant in incidence between both groups of patients (OR = 1.92, CI95% = 0.75-4.91). Conclusions: Limited lymphadenectomy must be considered as the better recommendation for surgical treatment for GC in older adult patients, considering the oncological outcomes and lower rates of complications compared with more radical lymph node dissections.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | - Violeta Avendaño-Morales
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
| | - Isabella Van-Londoño
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | - Daniela Melo-Leal
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | | | - Luis Carlos Venegas-Sanabria
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | | | | | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
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Yim THJYZ, Tan KY. Functional Outcomes after Abdominal Surgery in Older Adults - How concerned are we about this? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108347. [PMID: 38657374 DOI: 10.1016/j.ejso.2024.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Amidst trends of a rapidly ageing population with better surgical outcomes for geriatric patients, it is imperative to consider outcome measures beyond mortality and morbidity rates. In fact, the preservation of one's postoperative function has been cited as a key priority for older adults and is a crucial determinant of postoperative independence and survival. This review aims to examine the prevalence of perioperative function reporting amongst older surgical patients undergoing elective major abdominal surgery for cancer. We systematically reviewed studies from inception to December 2023 for studies which focused on the outcomes of older surgical patients undergoing elective major abdominal surgery for cancer. Relevant citations were screened (title, abstract and full article review) based on the inclusion and exclusion criteria. 103 studies were included, of which only 31 studies consisting of 20885 participants reported perioperative function. While the nominal number of studies which report perioperative function has been on a steady rise since 2018, the proportion of studies which do so remains low. Postoperative function is three times less likely to be reported than preoperative function, suggesting that functional recovery is not sufficiently assessed. This suggests that there is still a poor uptake of functional recovery as an outcome measure amongst surgeons, and any increase in perioperative function reporting is likely due to the increased administration of frailty assessments. These findings should urge greater efforts in quantifying and enabling functional recovery to improve the clinical outcomes and quality of care for older surgical patients.
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Affiliation(s)
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central Singapore 768828.
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Hallet J, Rousseau M, Gupta V, Hirpara D, Zhao H, Coburn N, Darling G, Kidane B. Long-term Functional Outcomes Among Older Adults Undergoing Video-assisted Versus Open Surgery for Lung Cancer: A Population-based Cohort Study. Ann Surg 2023; 277:e1348-e1354. [PMID: 35129475 DOI: 10.1097/sla.0000000000005387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the long-term healthcare dependency outcomes of older adults undergoing VATS compared to open lung cancer resection. SUMMARY OF BACKGROUND DATA Although the benefits of VATS for lung cancer resection have been reported, there is a knowledge gap related to long-term functional outcomes central to decision-making for older adults. METHODS We conducted a population-based retrospective comparative cohort study of patients ≥70 years old undergoing lung cancer resection between 2010 and 2017 using linked administrative health databases. VATS was compared to open surgery for lung cancer resection. Outcomes were receipt of homecare and high time-at-home, defined as <14 institution-days within 1 year, in 5 years after surgery. We used time-to-event analyses. Homecare was analyzed as recurrent dichotomous outcome with Andersen-Gill multivariable models, and high time-at-home with Cox multivariable models. RESULTS Of 4974 patients, 2951 had VATS (59.3%). In the first three months postoperatively, homecare use ranged from 17.5% to 34.4% for VATS and 23.0% to 36.6% for open surgery. VATS was independently associated with lower need for postoperative homecare over 5 years (hazard ratio 0.82, 95% confidence interval 0.74-0.92). 1- and 5-year probability of high "time-at-home" were superior for VATS (74.4% vs 66.7% and 55.6% vs 45.4%, p < 0.001). VATS was independently associated with higher probability of high "time-at-home" (hazard ratio 0.81, 95% confidence interval 0.74-0.89) compared to open surgery. CONCLUSIONS Compared to open surgery, VATS was associated with lower homecare needs and higher probability of high "time-at-home," indicating reduced long-term functional dependence. Those important patient-centered endpoints reflect the overall long-term treatment burden on mortality and morbidity that can inform surgical decision-making.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Center - Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Mathieu Rousseau
- Department of Thoracic Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dhruvin Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Center - Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Gail Darling
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
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Watanabe T, Ohno R, Kajitani R, Sahara K, Munechika T, Matsumoto Y, Aisu N, Kojima D, Yoshimatsu G, Hasegawa S. Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer. Int J Colorectal Dis 2023; 38:149. [PMID: 37256438 DOI: 10.1007/s00384-023-04440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Elderly people are thought to be more likely than their non-elderly counterparts to experience a decline in activities of daily living (ADL) and quality of life (QOL) due to the onset and treatment of disease. In this study, we investigated whether there was an age-related difference in changes in health-related QOL indices after surgical resection of colorectal cancer (CRC). METHODS Patients who underwent elective surgery for primary CRC at our hospital between September 2017 and November 2021 were enrolled. Changes in QOL after surgery were evaluated after dividing the study population into a non-elderly (NE) group (younger than 75 years) and an elderly (E) group. A Short-Form 36-Item Health Survey was used as an index of QOL. The subscale and component summary scores before and 6 months after surgery were compared. RESULTS Forty-seven patients were included in the E group and 166 patients were the NE group. The E group had significantly worse preoperative performance and physical status than the NE group. However, indices of physical function were not worsened after surgery in either group. In the NE group, there were significant decreases in role physical and role component summary scores and significant increases in general health, mental health, and mental component summary scores. In the E group, there were no significant changes in the subscale or component summary scores after surgery. CONCLUSION Our study demonstrated elderly patient did not necessarily show a decline in QOL more than non-elderly patients after CRC surgery. Surgical resection for CRC should be considered even for elderly patients, while considering possible risk factors for worsening ADL and QOL.
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Affiliation(s)
- Toshifumi Watanabe
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan.
| | - Ryo Ohno
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Kurumi Sahara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Taro Munechika
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Daibo Kojima
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
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Okuyama A, Kosaka H, Kaibori M, Higashi T, Ogawa A. Activities of daily living after surgery among older patients with gastrointestinal and hepatobiliary-pancreatic cancers: a retrospective observational study using nationwide health services utilisation data from Japan. BMJ Open 2023; 13:e070415. [PMID: 37230526 DOI: 10.1136/bmjopen-2022-070415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES The effectiveness and impact of any treatment on patients' physical functions, especially in older patients, should be closely considered. This study aimed to evaluate activities of daily living (ADLs) after oncological surgery in patients with gastrointestinal and hepatobiliary-pancreatic cancers by age groups in Japan. DESIGN Retrospective observational study using health services utilisation data from 1 January 2015 to 31 December 2016. SETTING Data for patients with gastrointestinal and hepatobiliary-pancreatic cancers diagnosed in 2015 from 431 hospitals nationwide in Japan. PARTICIPANTS Patients who underwent endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) and laparoscopic or open surgery were included. OUTCOME MEASURES The proportion of ADL decline at discharge, death and unexpected readmission within 6 weeks postsurgery was calculated by age groups (40-74, 75-79 and ≥80 years). RESULTS Data for 68 032 patients were analysed. The difference in the proportion of ADL decline after ESD/EMR between patients aged ≥80 years and <75 years was marginal (0.8%-2.5%), whereas that after laparoscopic (4.8%-5.9%) or open surgery (4.6%-9.4%) was large, except for pancreatic cancer (3.0%). Among patients with gastric cancer who underwent laparoscopic or open surgery, the proportion of unexpected readmission tended to be higher in patients aged ≥80 years than in the remaining younger patients (laparoscopic surgery 4.8% vs 2.3% (p=0.001); open surgery 7.3% vs 4.4% (p<0.001)). The postoperative mortality rate was <3% (<10 cases) across all ages and cancer types. CONCLUSIONS In ESD/EMR, postoperative ADL decline was almost the same between older and younger patients. Laparoscopic or open surgery is associated with increased rates of ADL decline in older patients, especially in those aged ≥80 years. The potential decline in ADLs should be carefully considered preoperatively to best maintain the patient's quality of life postsurgery.
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Affiliation(s)
- Ayako Okuyama
- Graduate School of Nursing, St Luke's International University, Chuo-ku, Tokyo, Japan
- Institute for Cancer Control, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Hisashi Kosaka
- Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takahiro Higashi
- Institute for Cancer Control, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Asao Ogawa
- Psycho-Oncology Division, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Japan, Kashiwa, Chiba, Japan
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Iwamoto SJ, Defreyne J, Kaoutzanis C, Davies RD, Moreau KL, Rothman MS. Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults. Ther Adv Endocrinol Metab 2023; 14:20420188231166494. [PMID: 37113210 PMCID: PMC10126651 DOI: 10.1177/20420188231166494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
As the transgender and gender diverse (TGD) population ages, more transfeminine and transmasculine individuals present to clinic to initiate or continue their gender-affirming care at older ages. Currently available guidelines on gender-affirming care are excellent resources for the provision of gender-affirming hormone therapy (GAHT), primary care, surgery, and mental health care but are limited in their scope as to whether recommendations require tailoring to older TGD adults. Data that inform guideline-recommended management considerations, while informative and increasingly evidence-based, mainly come from studies of younger TGD populations. Whether results from these studies, and therefore recommendations, can or should be extrapolated to aging TGD adults remains to be determined. In this perspective review, we acknowledge the lack of data in older TGD adults and discuss considerations for evaluating cardiovascular disease, hormone-sensitive cancers, bone health and cognitive health, gender-affirming surgery, and mental health in the older TGD population on GAHT.
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Affiliation(s)
- Sean J. Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Avenue, Aurora, CO 80045, USA
- Endocrinology Service, Medicine Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Robert D. Davies
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- CUMedicine LGBTQ Mental Health Clinic, University of Colorado Hospital, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
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10
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Nakazono M, Aoyama T, Komori K, Watanabe H, Kano K, Nagasawa S, Segami K, Tamagawa H, Yukawa N, Rino Y, Ogata T, Oshima T. The Comparison of the Dietary Intake Loss Between Elderly and Non-Elderly Patients After Gastrectomy for Gastric Cancer. J Gastrointest Cancer 2023; 54:35-43. [PMID: 34978046 PMCID: PMC10182928 DOI: 10.1007/s12029-021-00776-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM The present study quantified the changes in the dietary and nutritional intake after gastrectomy between elderly and non-elderly patients. PATIENTS AND METHODS This prospective observational study enrolled patients who underwent curative gastrectomy for gastric cancer. RESULTS Twenty-three patients ≥ 75 years old were classified into the elderly group, and 127 patients < 75 years old were classified into the non-elderly group. The respective median % dietary intake losses at 1 and 3 months postoperatively were -12.4% and -5.3% in the elderly group and -8.3% and -2.8% in the non-elderly group (p = 0.075 and 0.080). On comparing the intake loss of three major nutrients, the respective median % lipid intake losses at 1 and 3 months postoperatively were -13.5% and -5.8% in the elderly group and -7.3% and 0% in the non-elderly group (p = 0.029 and 0.045). CONCLUSION Our results suggested that elderly patients experienced more serious lipid intake loss after gastrectomy than non-elderly patients.
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Affiliation(s)
- Masato Nakazono
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
- Department of Surgery, Yokohama City University, Yokohama, Japan.
| | - Keisuke Komori
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Hayato Watanabe
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Kazuki Kano
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | | | - Kenki Segami
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
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11
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Hallet J, Zuckerman J, Guttman MP, Chesney TR, Haas B, Mahar A, Eskander A, Chan WC, Hsu A, Barabash V, Coburn N. Patient-Reported Symptom Burden After Cancer Surgery in Older Adults: A Population-Level Analysis. Ann Surg Oncol 2023; 30:694-708. [PMID: 36068425 DOI: 10.1245/s10434-022-12486-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/06/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults have unique needs for supportive care after surgery. We examined symptom trajectories and factors associated with high symptom burden after cancer surgery in older adults. PATIENTS AND METHODS We conducted a population-level study of patients ≥ 70 years old undergoing cancer surgery (2007-2018) using prospectively collected Edmonton Symptom Assessment System (ESAS) scores. The monthly prevalence of moderate to severe symptoms (ESAS ≥ 4) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and poor wellbeing was computed over 12 months after surgery. RESULTS Among 48,748 patients, 234,420 ESAS scores were recorded over 12 months after surgery. Moderate to severe tiredness (57.8%), poor wellbeing (51.9%), and lack of appetite (39.3%) were most common. The proportion of patients with moderate to severe symptoms was stable over the 1 month prior to and 12 months after surgery (< 5% variation for each symptom). There was no clinically significant change (< 5%) in symptom trajectory with the initiation of adjuvant therapy. CONCLUSIONS Patient-reported symptom burden was stable for up to 1 year after cancer surgery among older adults. Neither surgery nor adjuvant therapy coincided with a worsening in symptom burden. However, the persistence of symptoms at 1 year may suggest gaps in supportive care for older adults. This information on symptom trajectory and predictors of high symptom burden is important to set appropriate expectations and improve patient counseling, recovery care pathways, and proactive symptom management for older adults after cancer surgery.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. .,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Jesse Zuckerman
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Matthew P Guttman
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Unity Health, Toronto, ON, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Antoine Eskander
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Amy Hsu
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Victoria Barabash
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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12
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Behman R, Chesney T, Coburn N, Haas B, Bubis L, Zuk V, Ashamalla S, Zhao H, Mahar A, Hallet J. Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults: A Population-based Analysis of Long-term Functional Outcomes. Ann Surg 2023; 277:291-298. [PMID: 34417359 DOI: 10.1097/sla.0000000000005151] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection. BACKGROUND Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown. METHODS We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models. RESULTS Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68-0.75). CONCLUSIONS Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.
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Affiliation(s)
- Ramy Behman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tyler Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Saint Michael's Hospital - Unity Health, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lev Bubis
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Zuk
- Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
| | - Shady Ashamalla
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Haoyu Zhao
- ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
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13
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Fokas E, Glynne-Jones R, Fleischmann M, Piso P, Tselis N, Ghadimi M, Hofheinz RD, Rödel C. Radiotherapy dose escalation using endorectal brachytherapy in elderly and frail patients with rectal cancer unsuitable for surgery: Lessons from studies in fit patients and future perspectives. Cancer Treat Rev 2023; 112:102490. [PMID: 36463667 DOI: 10.1016/j.ctrv.2022.102490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Epidemiological data indicate that more than 50 % of patients with newly-diagnosed rectal cancer are older than 70 years, with rising numbers expected over the next decades. Treatment decision-making is challenging in elderly and frail patients with rectal cancer, whereas standardized treatment guidelines for this patient cohort are lacking. Elderly and frail rectal cancer patients are often considered by surgeons as unfit to undergo radical surgery as the risk of surgical complications and postoperative mortality rises with increasing age and comorbidity. Furthermore, these patients often receive no treatment at all, resulting in local and/or systemic disease progression with associated symptoms and impaired quality of life (QoL). Recent data from randomized trials in young fit patients with early stage rectal cancer indicate that RT dose escalation can be safely delivered using external beam (chemo)radiotherapy (EBRT) followed by endoluminal radiotherapeutic modalities, such as contact X-ray brachytherapy (CXB) or high-dose rate endorectal brachytherapy (HDR-BT). However, prospective studies testing this therapeutic concept in elderly and frail patients remain limited. Here, we review the current evidence in the epidemiology and the management of elderly and frail patients with rectal cancer. We summarize the potential of RT dose escalation to achieve long-term local control of the primary tumour, prevent disease-related morbidity, improve QoL and even organ preservation. Future perspectives and open questions will be discussed as well.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany.
| | - Robert Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK
| | - Maximillian Fleischmann
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Barmherzige Brüder Hospital, 93049 Regensburg, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, University Heidelberg, Heidelberg, Germany
| | - Claus Rödel
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
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14
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Hallet J, Tillman B, Zuckerman J, Guttman MP, Chesney T, Mahar AL, Chan WC, Coburn N, Haas B. Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis. J Natl Compr Canc Netw 2022; 20:1223-1232.e9. [PMID: 36351336 DOI: 10.6004/jnccn.2022.7052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although frailty is known to impact short-term postoperative outcomes, its long-term impact is unknown. This study examined the association between frailty and remaining alive and at home after cancer surgery among older adults. METHODS Adults aged ≥70 years undergoing cancer resection were included in this population-based retrospective cohort study using linked administrative datasets in Ontario, Canada. The probability of remaining alive and at home in the 5 years after cancer resection was evaluated using Kaplan-Meier methods. Extended Cox regression with time-varying effects examined the association between frailty and remaining alive and at home. RESULTS Of 82,037 patients, 6,443 (7.9%) had preoperative frailty. With median follow-up of 47 months (interquartile range, 23-81 months), patients with frailty had a significantly lower probability of remaining alive and at home 5 years after cancer surgery compared with those without frailty (39.1% [95% CI, 37.8%-40.4%] vs 62.5% [95% CI, 62.1%-63.9%]). After adjusting for age, sex, rural living, material deprivation, immigration status, cancer type, surgical procedure intensity, year of surgery, and receipt of perioperative therapy, frailty remained associated with increased hazards of not remaining alive and at home. This increase was highest 31 to 90 days after surgery (hazard ratio [HR], 2.00 [95% CI, 1.78-2.24]) and remained significantly elevated beyond 1 year after surgery (HR, 1.56 [95% CI, 1.48-1.64]). This pattern was observed across cancer sites, including those requiring low-intensity surgery (breast and melanoma). CONCLUSIONS Preoperative frailty was independently associated with a decreased probability of remaining alive and at home after cancer surgery among older adults. This relationship persisted over time for all cancer types beyond short-term mortality and the initial postoperative period. Frailty assessment may be useful for all candidates for cancer surgery, and these data can be used when counseling, selecting, and preparing patients for surgery.
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Affiliation(s)
- Julie Hallet
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 2Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
- 3ICES, Toronto, Ontario
- 4Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario
| | - Bourke Tillman
- 3ICES, Toronto, Ontario
- 5Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
| | - Jesse Zuckerman
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 3ICES, Toronto, Ontario
| | - Matthew P Guttman
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 3ICES, Toronto, Ontario
| | - Tyler Chesney
- 1Department of Surgery, University of Toronto, Toronto, Ontario
| | - Alyson L Mahar
- 3ICES, Toronto, Ontario
- 6Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Natalie Coburn
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 2Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
- 3ICES, Toronto, Ontario
- 4Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario
| | - Barbara Haas
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 3ICES, Toronto, Ontario
- 4Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario
- 6Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Meert G, Kenis C, Milisen K, Debruyne PR, De Groof I, Focan C, Cornélis F, Verschaeve V, Bachmann C, Bron D, Den Bulck HV, Schrijvers D, Langenaeken C, Specenier P, Jerusalem G, Praet JP, Lobelle JP, Flamaing J, Wildiers H, Decoster L. Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study. J Geriatr Oncol 2022; 13:1162-1171. [PMID: 36085275 DOI: 10.1016/j.jgo.2022.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline. MATERIAL AND METHODS This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL. RESULTS Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2-4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression. DISCUSSION Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.
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Affiliation(s)
- Glen Meert
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Philip R Debruyne
- Department of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Inge De Groof
- Department of Geriatric Medicine, St. Augustinus, Wilrijk, Belgium
| | - Christian Focan
- Department of Oncology, Clinique CHC Montlégia, Liège, Belgium
| | - Frank Cornélis
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Vincent Verschaeve
- Department of Medical Oncology, GHDC Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Dominique Bron
- Department of Hematology, ULB Institut Jules Bordet, Brussels, Belgium
| | | | - Dirk Schrijvers
- Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Christine Langenaeken
- Department Medical Oncology, Iridium Cancer Network Antwerp, AZ Klina, Brasschaat, Belgium
| | - Pol Specenier
- Department of Medical Oncology, University Hospital Antwerp, Antwerp, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman and Liege University, Liege, Belgium
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, CHU St-Pierre, Free Universities Brussels, Brussels, Belgium
| | - Jean-Pierre Lobelle
- Consultant in Statistics, Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven - University of Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Lore Decoster
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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16
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Delvecchio A, Conticchio M, Riccelli U, Ferraro V, Ratti F, Gelli M, Anelli FM, Laurent A, Vitali GC, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, Di Benedetto F, de'Angelis N, Briceño-Delgado J, Adam R, Cherqui D, Aldrighetti L, Memeo R. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis. HPB (Oxford) 2022; 24:933-941. [PMID: 34815189 DOI: 10.1016/j.hpb.2021.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 09/01/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection is a first-line curative option for hepatocellular carcinoma, but its role is still unclear in elderly patients. The aim of our study was to compare short- and long-term outcomes of laparoscopic and open liver resection in elderly patients with hepatocellular carcinoma. METHODS The study included 665 consecutive hepatocellular carcinoma liver resection cases in patients with ≥70 years of age treated in eight European hospital centres. Patients were divided into laparoscopic and open liver resection groups. Perioperative and long-term outcomes were compared between these groups. RESULTS After a 1:1 propensity score matching, 219 patients were included in each group. Clavien-Dindo grades III/IV (6 vs. 20%, p = 0.04) were lower in the laparoscopic than in the open matched group. Hospital stay was shorter in the laparoscopic than in the open matched group (5 vs. 7 days, p < 0.001). There were no significant differences between laparoscopic and open groups regarding overall survival and disease-free survival at 1-, 3- and 5- year periods. CONCLUSION Laparoscopic liver resection for hepatocellular carcinoma is associated with good short-term outcomes in patients with ≥70 years of age compared to open liver resection. Laparoscopic liver resection is safe and feasible in elderly patients with hepatocellular carcinoma.
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Affiliation(s)
| | | | - Umberto Riccelli
- Maxillo-Facial Surgery, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Valentina Ferraro
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy
| | - Francesca Ratti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maximiliano Gelli
- Department of Surgical Oncology, Institute of Oncology Gustave Roussy, Villejuif, France; Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Ferdinando M Anelli
- Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Alexis Laurent
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France
| | - Giulio C Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuele Felli
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - Taiga Wakabayashi
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - Patrick Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France; Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France
| | - Javier Briceño-Delgado
- Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Rene Adam
- Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Daniel Cherqui
- Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy.
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Ketelaers SHJ, Jacobs A, Verrijssen ASE, Cnossen JS, van Hellemond IEG, Creemers GJM, Schreuder RM, Scholten HJ, Tolenaar JL, Bloemen JG, Rutten HJT, Burger JWA. A Multidisciplinary Approach for the Personalised Non-Operative Management of Elderly and Frail Rectal Cancer Patients Unable to Undergo TME Surgery. Cancers (Basel) 2022; 14:2368. [PMID: 35625976 PMCID: PMC9139821 DOI: 10.3390/cancers14102368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
Despite it being the optimal curative approach, elderly and frail rectal cancer patients may not be able to undergo a total mesorectal excision. Frequently, no treatment is offered at all and the natural course of the disease is allowed to unfold. These patients are at risk for developing debilitating symptoms that impair quality of life and require palliative treatment. Recent advancements in non-operative treatment modalities have enhanced the toolbox of alternative treatment strategies in patients unable to undergo surgery. Therefore, a proposed strategy is to aim for the maximal non-operative treatment, in an effort to avoid the onset of debilitating symptoms, improve quality of life, and prolong survival. The complexity of treating elderly and frail patients requires a patient-centred approach to personalise treatment. The main challenge is to optimise the balance between local control of disease, patient preferences, and the burden of treatment. A comprehensive geriatric assessment is a crucial element within the multidisciplinary dialogue. Since limited knowledge is available on the optimal non-operative treatment strategy, these patients should be treated by dedicated multidisciplinary rectal cancer experts with special interest in the elderly and frail. The aim of this narrative review was to discuss a multidisciplinary patient-centred treatment approach and provide a practical suggestion of a successfully implemented clinical care pathway.
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Affiliation(s)
- Stijn H. J. Ketelaers
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Anne Jacobs
- Department of Gerontology and Geriatrics, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - An-Sofie E. Verrijssen
- Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (A.-S.E.V.); (J.S.C.)
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (A.-S.E.V.); (J.S.C.)
| | - Irene E. G. van Hellemond
- Department of Medical Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (I.E.G.v.H.); (G.-J.M.C.)
| | - Geert-Jan M. Creemers
- Department of Medical Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (I.E.G.v.H.); (G.-J.M.C.)
| | - Ramon-Michel Schreuder
- Department of Gastroenterology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - Harm J. Scholten
- Department of Anaesthesiology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - Jip L. Tolenaar
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Johanne G. Bloemen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Harm J. T. Rutten
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
- GROW, School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jacobus W. A. Burger
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
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Muhandiramge J, Orchard SG, Warner ET, van Londen GJ, Zalcberg JR. Functional Decline in the Cancer Patient: A Review. Cancers (Basel) 2022; 14:1368. [PMID: 35326520 PMCID: PMC8946657 DOI: 10.3390/cancers14061368] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
A decline in functional status, an individual's ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing. Functional decline, however, appears to be accelerated in older patients with cancer. Such decline can occur as a result of a cancer itself, cancer treatment-related factors, or a combination of the two. The accelerated decline in function seen in older patients with cancer can be slowed, or even partly mitigated through routine assessments of functional status and timely interventions where appropriate. This is particularly important given the link between functional decline and impaired quality of life, increased mortality, comorbidity burden, and carer dependency. However, a routine assessment of and the use of interventions for functional decline do not typically feature in the long-term care of cancer survivors. This review outlines the link between cancer and subsequent functional decline, as well as potential underlying mechanisms, the tools that can be used to assess functional status, and strategies for its prevention and management in older patients with cancer.
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Affiliation(s)
- Jaidyn Muhandiramge
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.M.); (S.G.O.)
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.M.); (S.G.O.)
| | - Erica T. Warner
- Clinical and Translational Epidemiology Unit, MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | | | - John R. Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.M.); (S.G.O.)
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC 3004, Australia
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19
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Mei F, Yang X, Na L, Yang L. Anal preservation on the psychology and quality of life of low rectal cancer. J Surg Oncol 2022; 125:484-492. [PMID: 34750821 DOI: 10.1002/jso.26741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 10/31/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aims of this study are to evaluate depression and quality of life (QOL) after laparoscopic abdominoperineal resection (LAPR) or transanal total mesorectal excision (TaTME) surgery in low rectal cancer (RC) patients. METHODS This is a prospective observational cohort study. Patients were divided into two groups: either TaTME surgery or LAPR. Psychosocial distress and QOL were assessed using a questionnaire before surgery, at 6 months postsurgery, and 12 months postsurgery. The Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression. The European Organization for Research and Treatment of Cancer-QOL questionnaire core was used to estimate the QOL. RESULTS In the TaTME group, the scores of psychosocial distress and QOL showed an obvious tendency to decrease and then recover. Meanwhile, in the LAPR group, these scores deteriorated significantly at 6 and 12 months, and the recovery was less pronounced. Multivariable analysis suggested that surgical options and tumor stage were significantly associated with psychosocial distress and QOL. CONCLUSION For low RC, TaTME could significantly improve patients' QOL and reduce psychological distress as compared to patients with LAPR at 12 months after surgery.
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Affiliation(s)
- Feng Mei
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Yang
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lina Na
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liu Yang
- Department of Colorectal Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Horinishi Y, Shimizu K, Sano C, Ohta R. Surgical Interventions in Cases of Esophageal Hiatal Hernias among Older Japanese Adults: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:279. [PMID: 35208602 PMCID: PMC8876223 DOI: 10.3390/medicina58020279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Given Japan's superaging population, an increasing number of older adults in the country need surgical treatment for esophageal hiatal hernias. Accordingly, this systematic review examines surgical interventions for symptomatic esophageal hiatal hernias in older Japanese patients and explores treatment outcomes. Materials and Methods: Articles on single operations for hiatal hernias published after 1991 were found on Google Scholar and Ichushi using specific keywords. Subsequently, articles fulfilling the predetermined inclusion criteria were considered in the study. Results: The mean patient age was 81.4 years, and the male-to-female ratio was 1:11.5. The main reasons for surgery were vomiting, dyspnea, and chest tightness. In terms of hernia classification, type IV was the most common (48%). Surgical modalities were laparoscopy in 15 cases, and laparotomy in 10 cases. Mean postoperative course was 26.47 days until hospital discharge, and there were no cases of perioperative death. Conclusions: Findings showed that multiple factors were involved in older adults' prognoses, and age was not the only biological factor. Therefore, aggressive surgical intervention should be considered for symptomatic older patients, even in the absence of surgery indicators.
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Affiliation(s)
- Yuta Horinishi
- Matsue Seikyo General Hospital, 8-8-8 Nishituda, Matsue 690-8522, Shimane, Japan;
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
| | - Kai Shimizu
- Huchu Hospital, 1-10-17, Huchu-Town, Izumi 594-0076, Osaka, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan
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21
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Pang C, Hallet J, Chesney TR, Haas B, Wright FC, Gotlib Conn L. Using Social Science Theory Can Change How the Patient Experience Is Viewed in Surgical Care. Ann Surg 2022; 275:e284-e285. [PMID: 34171872 DOI: 10.1097/sla.0000000000005021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Celeste Pang
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Julie Hallet
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Barbara Haas
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Frances C Wright
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
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22
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Haase KR, Tompson MA, Hall S, Sattar S, Ahmed S. Engaging Older Adults With Cancer and Their Caregivers to Set Research Priorities Through Cancer and Aging Research Discussion Sessions. Oncol Nurs Forum 2021; 48:613-622. [PMID: 34673758 DOI: 10.1188/21.onf.613-622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report on the perspectives of older adults (aged older than 65 years) with cancer and their caregivers who participated in patient-oriented research priority-setting activities called the Cancer and Aging Research Discussion Sessions. PARTICIPANTS & SETTING 35 older adults and caregivers participated in three public meetings and follow-up interviews. METHODOLOGIC APPROACH Qualitative descriptive. FINDINGS There was clear consensus from participants on research priorities related to two key areas. IMPLICATIONS FOR NURSING Future research should focus on addressing age-related disparities in cancer care communication and support. By capitalizing on older adults' interest in research engagement, effective solutions can be cocreated to improve cancer experiences for older adults and their caregivers.
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23
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Bruijnen CP, de Groot LGR, Vondeling AM, de Bree R, van den Bos F, Witteveen PO, Emmelot-Vonk MH. Functional decline after surgery in older patients with head and neck cancer. Oral Oncol 2021; 123:105584. [PMID: 34742007 DOI: 10.1016/j.oraloncology.2021.105584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients ≥ 70 years one year after surgery for head and neck cancer. METHODS We present one-year follow-up data of patients ≥ 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively. RESULTS In total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42,p-value 0.00 and mean 1.21 versus 1.94,p-value 0.00). There was no significant change concerning ADL dependence (p-value 0.18) and cognitive status (p-value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25,p-value 0.12). CONCLUSION Approximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency.
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Affiliation(s)
- Cheryl P Bruijnen
- The department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Lotte G R de Groot
- The department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ariel M Vondeling
- The department of Geriatrics, Diakonessenhuis, Utrecht, the Netherlands
| | - Remco de Bree
- The department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frederiek van den Bos
- The department of Geriatrics, Leids University Medical Center, Leiden, the Netherlands
| | - Petronella O Witteveen
- The department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Angarita FA, Hoppe EJ, Ko G, Lee J, Vesprini D, Hong NJL. Why do Older Women Avoid Breast Cancer Surgery? A Qualitative Analysis of Decision-making Factors. J Surg Res 2021; 268:623-633. [PMID: 34474211 DOI: 10.1016/j.jss.2021.06.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few studies have explored why older women (≥70 years old) avoid breast cancer surgery. This study aimed to identify physician- and patient-perceived attitudes that influence the decision to avoid surgery among older women with invasive breast cancer. METHODS Semi-structured in-depth interviews were conducted with multidisciplinary breast cancer specialists and older women (≥70 years old) with breast cancer who declined surgery. Transcripts were iteratively coded using a theoretical framework to guide identification of common themes. Thematic comparison was performed between patients and physicians. RESULTS Ten breast cancer specialists and eleven patients participated. Physicians believed older women declined surgery because they did not perceive breast cancer as a life-threatening ailment compared to other medical comorbidities. Physicians did not discuss breast reconstruction, as it was perceived to be unimportant. Treatment side effects, length of treatment, impact on quality of life, and minimal survival benefit strongly influenced patients' decision to decline surgery. Patients valued independence and quality of life over quantity of life. Patients felt empowered to participate in the decision-making process but appreciated having support. Both phyisicians and patients had congruent beliefs with respect to age impacting treatment decision, cosmesis playing a minor factor in treatment decisions, and importance of quality of life; however, they were discordant in their perceptions about the amount of support that patients have from their families. CONCLUSIONS The decision to avoid surgery in older women stems from a variety of individual beliefs. Acknowledging patient values early in treatment planning may facilitate a patient-centered approach to the decision-making process.
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Affiliation(s)
| | - Ethan J Hoppe
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gary Ko
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Lee
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Charles EJ, Mehaffey JH, Hawkins RB, Burks SG, McMurry TL, Yarboro LT, Kern JA, Ailawadi G, Kron IL, Stukenborg GJ, Kozower BD. Meaningful Patient-centered Outcomes 1 Year Following Cardiac Surgery. Ann Surg 2021; 273:e247-e254. [PMID: 31397691 DOI: 10.1097/sla.0000000000003357] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate meaningful, patient-centered outcomes including alive-at-home status and patient-reported quality of life 1 year after cardiac surgery. BACKGROUND Long-term patient-reported quality of life after cardiac surgery is not well understood. Current operative risk models and quality metrics focus on short-term outcomes. METHODS In this combined retrospective/prospective study, cardiac surgery patients at an academic institution (2014-2015) were followed to obtain vital status, living location, and patient-reported outcomes (PROs) at 1 year using the NIH Patient-Reported Outcomes Measurement Information System (PROMIS). We assessed the impact of cardiac surgery, discharge location, and Society of Thoracic Surgeons perioperative predicted risk of morbidity or mortality on 1-year outcomes. RESULTS A total of 782 patients were enrolled; 84.1% (658/782) were alive-at-home at 1 year. One-year PROMIS scores were global physical health (GPH) = 48.8 ± 10.2, global mental health (GMH) = 51.2 ± 9.6, and physical functioning (PF) = 45.5 ± 10.2 (general population reference = 50 ± 10). All 3 PROMIS domains at 1 year were significantly higher compared with preoperative scores (GPH: 41.7 ± 8.5, GMH: 46.9 ± 7.9, PF: 39.6 ± 9.0; all P < 0.001). Eighty-two percent of patients discharged to a facility were alive-at-home at 1 year. These patients, however, had significantly lower 1-year scores (difference: GPH = -5.1, GMH = -5.1, PF = -7.9; all P < 0.001). Higher Society of Thoracic Surgeons perioperative predicted risk was associated with significantly lower PRO at 1 year (P < 0.001). CONCLUSIONS Cardiac surgery results in improved PROMIS scores at 1 year, whereas discharge to a facility and increasing perioperative risk correlate with worse long-term PRO. One-year alive-at-home status and 1-year PRO are meaningful, patient-centered metrics that help define long-term quality and the benefit of cardiac surgery.
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Affiliation(s)
- Eric J Charles
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Robert B Hawkins
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Sandra G Burks
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy L McMurry
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Leora T Yarboro
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - John A Kern
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Irving L Kron
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - George J Stukenborg
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Bottom-Tanzer SF, Poyant JO, Louzada MT, Ahmed SE, Boudouvas A, Poon E, Hojman HM, Bugaev N, Johnson BP, Van Kirk AL, Daniel E, Emoff C, Mahoney EJ. High occurrence of postintensive care syndrome identified in surgical ICU survivors after implementation of a multidisciplinary clinic. J Trauma Acute Care Surg 2021; 91:406-412. [PMID: 34108416 DOI: 10.1097/ta.0000000000003231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postintensive care syndrome (PICS) has been identified in a large proportion of medical intensive care unit survivors; however, the occurrence surgical intensive care unit (SICU) survivors is unknown. We implemented a multidisciplinary critical care outpatient clinic (CCOC) to identify the occurrence of PICS in SICU survivors. METHODS Seventy acute care surgery and trauma patients, 18 years or older, who remained in the SICU for 72 hours or longer at a Level I trauma center were seen in CCOC at 2 weeks, 12 weeks, and 24 weeks after hospital discharge. The CCOC staffing included a nurse coordinator, social worker, critical care pharmacist, physical therapist, and acute care surgeon who identified PICS sequelae in their respective specialties by clinical criteria and screening questionnaires. RESULTS Of 82 eligible patients, 70 (85.4%) were seen at least once for 116 total visits. Forty-three (61.4%) patients suffered traumatic injuries and 27 (38.6%) underwent emergent general surgery. Sixty-seven (95.7%) demonstrated at least one PICS criterion. Over all visits, 26 (37.1%) patients presented with one PICS criterion, 24 (34.3%) patients with two, and 17 (24.3%) with three. Cognitive impairment was observed in 29 (41.4%) patients, psychiatric in 30 (42.9%), and physical symptoms in 65 (92.9%). Activity Measure for Post-Acute Care scores improved from severe impairment at admission to full function by 12 weeks postdischarge, yet 6 Minute Walk Test scores remained below age-matched references through all visits. Patients expressed mild to moderate depression based on Patient Health Questionnaire-9 scores. A medication reconciliation was completed at 96.5% (112/116) of the visits with 116 total medication recommendations. By 24 weeks following discharge, only 26.4% (14/53) of previously employed patients had resumed work. CONCLUSION Through the successful implementation of a multidisciplinary CCOC, this study identifies an exorbitant rate of PICS among SICU survivors. LEVEL OF EVIDENCE Therapeutic/epidemiological, level III.
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Affiliation(s)
- Samantha F Bottom-Tanzer
- From the Tufts University School of Medicine & Tufts Graduate School of Biomedical Sciences (S.F.B.-T.); Department of Pharmacy (J.O.P.), Tufts Medical Center; Department of General Surgery (M.T.L.), Tufts Medical Center, Tufts University School of Medicine; Department of Social Work Services (S.E.A., A.L.V.K., C.E.); Department of Physical and Occupational Therapy (A.B., E.P., E.D.), Tufts Medical Center; and Division of Trauma & Acute Care Surgery (H.M.H., N.B., B.P.J., E.J.M.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Honda Y, Takahashi K, Sasanuma N, Itani Y, Nagase M, Uchiyama Y, Tamaki A, Sakaguchi T, Domen K. Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery. Circ J 2021; 85:1020-1026. [PMID: 33642424 DOI: 10.1253/circj.cj-20-0909] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to investigate the trajectory of functional recovery of activities of daily living (ADL) from the time of admission up to hospital discharge, and explored which preoperative and postoperative variables were independently associated with functional decline in ADL at discharge of patients after cardiovascular surgery. METHODS AND RESULTS In this observational study, we evaluated ADL preoperatively and at discharge using the Functional Independence Measure (FIM) in patients after cardiovascular surgery. Functional decline in ADL was defined as scoring 1-5 on any one of the FIM items at discharge. Multiple logistic regression was performed to predict the functional decline in ADL at discharge. We found that 18.8% of elective cardiovascular surgery patients suffered from decreased ADL at discharge. The Mini-Mental State Examination (odds ratio (OR): 0.573, 95% confidence interval (CI): 0.420-0.783), gait speed (OR: 0.032, 95% CI: 0.003-0.304) and initiation of walking around the bed (OR: 1.277, 95% CI: 1.103-1.480) were independently associated with decreased ADL at discharge. CONCLUSIONS A functional decline in ADL at discharge can be predicted using preoperative measures of cognitive function, preoperative gait speed and postoperative day of initiation of walking. These results show that preoperative cognitive screening and gait speed assessments can be used to identify patients who might require careful postoperative planning, and for whom early postoperative rehabilitation is needed to prevent serious functional ADL deficits.
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Affiliation(s)
- Yosuke Honda
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Keiko Takahashi
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Naoki Sasanuma
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Yusuke Itani
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Masahiro Nagase
- Department of Rehabilitation, Hyogo College of Medicine College Hospital
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences
| | | | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine
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Hubbard TJE, Pringle H, Bethune R, McDermott FD. Survival outcomes of elderly patients referred to the lower gastrointestinal 2-week wait service. Colorectal Dis 2021; 23:1434-1443. [PMID: 33742557 DOI: 10.1111/codi.15620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 02/08/2023]
Abstract
AIM The benefit to elderly patients (≥80 years old) of referral to the resource-intensive lower gastrointestinal 2-week wait (LGI-2WW) pathway is unknown. The aim of this study was to investigate the survival outcome of elderly patients referred to a LGI-2WW service. METHOD This study comprised a retrospective analysis of a prospectively gathered database of patients referred to a single-centre LGI-2WW service and conformed to STROBE guidelines. The primary outcome was all-cause mortality. Statistical analysis was performed with the chi-square test and Kaplan-Meier survival curves compared with the generalized log-rank test. RESULTS A total of 10 155 patients referred to the LGI-2WW service between 1 January 2015 and 31 December 2018 were analysed; median follow-up was 37.0 months (range 0-66 months). Six hundred and ninety one cancers were diagnosed (6.8% detection rate); 551 (80%) of these were lower GI cancers (LGICas) [517 (75%) colorectal; 34 (5%) anal]. Forty per cent of LGICas were diagnosed via the LGI-2WW service. Patients aged ≥80 years with LGICa were more likely to be treated with palliative intent [age <80 years, 92/360 (26%) vs. age ≥80 years, 105/191 (55%); p < 0.001]. LGICa patients aged <85 years had a survival difference between those treated with curative intent (LGICa-Cur) or palliative intent (LGICa-Pal) (median survival for patients aged 80-84 years: LGICa-Cur 57 months vs. LGICa-Pal 15 months; p < 0.001). Patients aged ≥85 years did not have any survival difference by treatment intent (median survival for patients aged 85-89 years: LGICa-Cur 31 months vs. LGICa-Pal 16 months; p = 0.062; median survival for patients aged ≥90 years: LGICa-Cur 14 months vs. LGICa-Pal 16 months; p = 0.703). CONCLUSION Patients with LGICa aged ≥85 years have similar survival whether treated with curative or palliative intent. This can inform management discussions with patients and LGI-2WW referral pathway prioritization approaches.
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Affiliation(s)
- Thomas J E Hubbard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.,Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Heather Pringle
- Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Robert Bethune
- Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Frank D McDermott
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.,Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
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Nightingale G, Battisti NML, Loh KP, Puts M, Kenis C, Goldberg A, Haase KR, Krok-Schoen J, Liposits G, Sattar S, Stolz-Baskett P, Pergolotti M. Perspectives on functional status in older adults with cancer: An interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG. J Geriatr Oncol 2021; 12:658-665. [PMID: 33172805 PMCID: PMC8102651 DOI: 10.1016/j.jgo.2020.10.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/17/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022]
Abstract
Most adults with cancer are over 65 years of age, and this cohort is expected to grow exponentially. Older adults have an increased burden of comorbidities and risk of experiencing adverse events on anticancer treatments, including functional decline. Functional impairment is a predictor of increased risk of chemotherapy toxicity and shorter survival in this population. Healthcare professionals caring for older adults with cancer should be familiar with the concept of functional status and its implications because of the significant interplay between function, cancer, anticancer treatments, and patient-reported outcomes. In this narrative review, we provide an overview of functional status among older patients with cancer including predictors, screening, and assessment tools. We also discuss the impact of functional impairment on patient outcomes, and describe the role of individual members of an interprofessional team in addressing functional impairment in this population, including the use of a collaborative approach aiming to preserve function.
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Affiliation(s)
- Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Nicolò Matteo Luca Battisti
- Breast Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM1 2JP, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London SM2 5NG, United Kingdom
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Annette Goldberg
- Department of Nutrition, Dana Farber Cancer Institute, Boston, MA, USA
| | - Kristen R Haase
- School of Nursing, University of British Columbia, Wesbrook Mall, Vancouver, British Columbia, Canada
| | - Jessica Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gábor Liposits
- Department of Oncology, Regional Hospital West Jutland, Herning, Denmark
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Petra Stolz-Baskett
- Oncology Service, Nelson Hospital Nelson Marlborough Health, Nelson 7048, New Zealand
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical; Colorado State University, Fort Collins, CO, USA
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30
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Chesney TR, Haas B, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Wright F, Hsu AT, Hallet J. Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:888-895. [PMID: 32980211 DOI: 10.1016/j.ejso.2020.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Frailty is an important prognostic factor, and the association with postoperative dependence is important outcome to older adults. We examined the association of frailty with long-term homecare utilization for older adults following cancer surgery. METHODS In this population-based cohort study, we determined frailty status in all older adults (≥70 years old) undergoing cancer resection (2007-2017). Outcomes were receipt of homecare and intensity of homecare (days per month) over 5 years. We estimated the adjusted association of frailty with outcomes, and assessed interaction with age. RESULTS Of 82,037 patients, 6443 (7.8%) had frailty. Receipt and intensity of homecare was greater with frailty, but followed similar trajectories over 5 years between groups. Homecare receipt peaked in the first postoperative month (51.4% frailty, 43.1% no frailty), and plateaued by 1 year until 5 years (28.5% frailty, 12.8% no frailty). After 1 year, those with frailty required 4 more homecare days per month than without frailty (14 vs 10 days/month). After adjustment, frailty was associated with increased homecare receipt (hazard ratio 1.40; 95%CI 1.35-1.45), and increasing intensity each year (year 1 incidence rate ratio [IRR] 1.22, 95%CI 1.18-1.27 to year 5 IRR 1.47, 95%CI 1.35-1.59). The magnitude of the association of frailty with homecare receipt decreased with age (pinteraction <0.001). CONCLUSION While the trajectory of homecare receipt and intensity is similar between those with and without frailty, frailty is associated with increased receipt of homecare and increased intensity of homecare after cancer surgery across all age groups.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Frances Wright
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Saur NM, Montroni I, Audisio RA. Considerations in Surgical Management of Gastrointestinal Cancer in Older Patients. Curr Oncol Rep 2021; 23:8. [PMID: 33387059 DOI: 10.1007/s11912-020-00991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The goal of this manuscript is to present new and thought-provoking information related to the surgical care of older patients. We focused on four main areas including communication, surgical pathways, the care of emergency surgery patients, and functional recovery and quality of life. We sought to answer how these areas have evolved, affecting the care of older patients. RECENT FINDINGS Older patients with cancer present particular challenges in relation to communication, goals, surgical treatment, and post-surgical outcomes. Communication should be clear early and during the treatment course. A multidisciplinary, multimodality, multi-phase pathway can be utilized to improve the postoperative outcomes of older patients with cancer. Functional recovery and quality of life can and should be measured in this population. Communication is complicated in cancer patients, which is made more complex with advancing age. Communication is the cornerstone of the treatment of older patients. Future research should focus on interventions to improve communication and measure quality of life and functional recovery metrics.
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Affiliation(s)
- Nicole M Saur
- Department of Surgery, University of Pennsylvania, 800 Walnut Street 20th floor, Philadelphia, PA, 19107, USA.
| | - Isacco Montroni
- Department of General Surgery, Ospedale per gli Infermi, Viale Stradone 9, 48018, Faenza, RA, Italy
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Blå Stråket 5, 413 45, Göteborg, Sweden
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Charles EJ, Mehaffey JH, Hawkins RB, Green CJ, Craddock A, Tyerman ZM, Larson ND, Kron IL, Ailawadi G, Kozower BD. Effect of Cardiac Surgery on One-Year Patient-Reported Outcomes: A Prospective Cohort Study. Ann Thorac Surg 2020; 112:1410-1416. [PMID: 33309733 DOI: 10.1016/j.athoracsur.2020.09.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current cardiac surgery risk algorithms and quality measures focus on perioperative outcomes. However, delivering high-value, patient-centered cardiac care will require a better understanding of long-term patient-reported quality of life after surgery. Our objective was to prospectively assess the effect of cardiac surgery on long-term patient-reported outcomes. METHODS Patients undergoing cardiac surgery at an academic medical center (2016 to 2017) were eligible for enrollment. Patient-reported outcomes were measured using the National Institutes of Health Patient-Reported Outcomes Measurement Information System preoperatively and 1 year postoperatively across five domains: mental health, physical health, physical functioning, social satisfaction, and applied cognition. Baseline data and perioperative outcomes were obtained from The Society of Thoracic Surgeons Database. The effect of cardiac surgery on long-term patient-reported quality of life was assessed. RESULTS Ninety-eight patients were enrolled and underwent cardiac surgery, with 92.9% (91 of 98) successful follow-up. The most common operation was coronary artery bypass graft surgery at 63.3% (62 of 98), with 60.2% (59 of 98) undergoing an elective operation. One-year all-cause mortality was 5.1% (5 of 98). Rate of major morbidity was 11.2% (11 of 98). Cardiac surgery significantly improved patient-reported outcomes at 1 year across four domains: mental health (preoperative 47.3 ± 7.7 vs postoperative 51.1 ± 8.9, P < .001), physical health (41.2 ± 8.2 vs 46.3 ± 9.3, P < .001), physical functioning (39.8 ± 8.6 vs 44.8 ± 8.5, P < .001), and social satisfaction (46.8 ± 10.9 vs 50.7 ± 10.8, P = .023). Hospital discharge to a facility did not affect 1-year patient-reported outcomes. CONCLUSIONS Cardiac surgery improves long-term patient-reported quality of life. Mental, physical, and social well-being scores were significantly higher 1 year postoperatively. Data collection with the National Institutes of Health Patient-Reported Outcomes Measurement Information System provides meaningful, quantifiable results that may improve delivery of patient-centered care.
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Affiliation(s)
- Eric J Charles
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - China J Green
- Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia
| | - Ashley Craddock
- Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia
| | - Zachary M Tyerman
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nathaniel D Larson
- Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia
| | - Irving L Kron
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
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Kenig J, Mitus JW, Rapacz K, Skorus U, Pietrzyk P, Sega A. Usefulness of scoring systems in outcome prediction for older cancer patients undergoing abdominal surgery. Acta Chir Belg 2020; 120:383-389. [PMID: 31319764 DOI: 10.1080/00015458.2019.1642577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several postoperative outcome scoring systems have been developed and validated, combining both pre- and intraoperative factors. Among others are the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM), the Estimation of Physiologic Ability and Stress (E-PASS) and the Surgical Apgar Score combined with the American Society of Anesthesiologists physical status classification (SASA). The aim of this study was to compare the above scoring systems in the prediction of 30-day postoperative outcome in older patients with cancer undergoing abdominal surgery. METHODS Consecutive patients ≥70 years were prospectively enrolled. Pre- and intraoperative variables were used to calculate the scores, the ROC and perform logistic regression analysis. RESULTS The study sample comprised 201 patients with a median age of 77 (range 70-93) years. The most common surgical procedure was for colorectal (75%), followed by gastric (10.4%) pancreas (7.0%), gall bladder (3.5%), small bowel (2.5%), and other (1.5%) types of cancer. All scores were independent predictors of 30-day postoperative mortality. In case of 30-day morbidity only SASA turned to be significant. The ROC curves were highly valid and area under the curve showed fair to good discriminatory ability (0.60-0.77) for 30-day postoperative mortality and fair (AUC 0.6) in case of SASA for the 30-day postoperative. CONCLUSION The SASA, E-PASS, and P-POSSUM were confirmed to be predictive of 30-day postoperative mortality in older patients undergoing abdominal elective cancer surgery. Only SASA demonstrated as independent factor predicting postoperative 30-day major morbidity.
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Affiliation(s)
- Jakub Kenig
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy W. Mitus
- Department of Surgical Oncology, Centre of Oncology Maria Sklodowska-Curie Memorial Institute, Kraków, Poland
| | - Kamil Rapacz
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Urszula Skorus
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Paulina Pietrzyk
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Aurelia Sega
- Department of Clinical Nursing, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Kraków, Poland
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Chesney TR, Haas B, Coburn NG, Mahar AL, Zuk V, Zhao H, Wright FC, Hsu AT, Hallet J. Patient-Centered Time-at-Home Outcomes in Older Adults After Surgical Cancer Treatment. JAMA Surg 2020; 155:e203754. [PMID: 33026417 DOI: 10.1001/jamasurg.2020.3754] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Functional outcomes are central to cancer care decision-making by older adults. Objective To assess the long-term functional outcomes of older adults after a resection for cancer using time at home as the measure. Design, Setting, and Participants This population-based cohort study was conducted in Ontario, Canada, using the administrative databases stored at ICES (formerly the Institute for Clinical Evaluative Sciences). The analysis included adults 70 years or older with a new diagnosis of cancer between January 1, 2007, and December 31, 2017, who underwent a resection 90 days to 180 days after the diagnosis. Patients were followed up until and censored at the date of death, date of last contact, or December 31, 2018. Main Outcomes and Measures The main outcome was time at home, dichotomized as high time at home (defined as ≤14 institution days annually) and low time at home (defined as >14 institution days) during the 5 years after surgical cancer treatment. Time-to-event analyses with Kaplan-Meier methods and multivariable Cox proportional hazards regression models were used. Results A total of 82 037 patients were included, with a median (interquartile range) follow-up of 46 (23-80) months. Of these patients, 52 119 were women (63.5%) and the mean (SD) age was 77.5 (5.7) years. The median (interquartile range) number of days at home per days alive per patient was high, at 0.98 (0.94-0.99) in postoperative year 1, 0.99 (0.97-1.00) in year 2, 0.99 (0.96-1.00) in year 3, 0.99 (0.96-1.00) in year 4, and 0.99 (0.96-1.00) in year 5. The probability of high time at home was 70.3% (95% CI, 70.0%-70.6%) at postoperative year 1 and 53.2% (95% CI, 52.8%-53.5%) at postoperative year 5. Advancing age (≥85 years: hazard ratio [HR], 2.11; 95% CI, 2.04-2.18); preoperative frailty (HR, 1.74; 95% CI, 1.68-1.80); high material deprivation (5th quintile: HR, 1.25; 95% CI, 1.20-1.29); rural residency (HR, 1.14; 95% CI, 1.10-1.18); high-intensity surgical procedure (HR, 2.04; 95% CI, 1.84-2.25); and gastrointestinal (HR, 1.23; 95% CI, 1.18-1.27), gynecologic (HR, 1.31; 95% CI, 1.18-1.45), and oropharyngeal (HR, 1.05; 95% CI, 0.95-1.16) cancers were associated with low time at home. Inpatient acute care was responsible for 76.0% and long-term care was responsible for 2.0% of institution days in postoperative year 1. Inpatient days decreased to 31.0% by year 3, but days in long-term care increased over time. Conclusions and Relevance This study found that older adults predominantly experienced high time at home after resection for cancer, reflecting the overall favorable functional outcomes in this population. The oldest adults and those with preoperative frailty and material deprivation appeared to be the most vulnerable to low time at home, and efforts to optimize and manage expectations about surgical outcomes can be targeted for this population; this information is important for patient counseling regarding surgical cancer treatment and for preparation for postoperative recovery.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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35
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Kajino M, Tsushima E. Effects of physical activity on quality of life and physical function in postoperative patients with gastrointestinal cancer. Phys Ther Res 2020; 24:43-51. [PMID: 33981527 DOI: 10.1298/ptr.e10048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study was to clarify changes in physical function and quality of life (QOL) for postoperative, and to examine the influence of the amount of physical activity on these variables. METHODS This study included 29 patients who underwent gastrointestinal cancer surgery. The QOL measurement was used to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for preoperative and 2nd and 4th postoperative weeks. Physical function measured knee extension strength, 4 m walk time, 5 times sit-to-stand test, and 6-minute walk for preoperative and 1st and 2nd postoperative weeks. The amount of physical activity score was based on METs-hours, which is estimated from cumulative physical activity. As basic characteristics were investigated cancer stage, comorbidities and complications, and operative. Statistical analysis was repeated measures analysis of variance was performed to observe postoperative changes in physical function and QOL. Furthermore, stepwise multiple regression analysis was used to the parameters of physical function and QOL affected by the physical activity score were investigated. RESULTS Physical function decreased postoperatively and generally improved 2nd postoperative week. Though scores on the QOL functional scales improved, some items did not improve sufficiently. Multiple regression analysis showed that physical activity score had an effect on constipation and emotion functioning. CONCLUSIONS Improvement in symptom scales is not sufficient in a short period of time, and they need to be followed up by increasing the amount of physical activity and promoting instantaneous exercise.
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Affiliation(s)
- Masaya Kajino
- Department of Rehabilitation, National Hospital Organization Kanmon Medical Center, Japan
| | - Eiki Tsushima
- Graduate School of Health Sciences, Hirosaki University, Japan
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36
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Sakamoto T, Yagyu Y, Uchinaka EI, Hanaki T, Miyatani K, Kihara K, Yamamoto M, Matsunaga T, Tokuyasu N, Honjo S, Fujiwara Y. Surgical Outcomes Following Early Drain Removal After Distal Pancreatectomy in Elderly Patients. In Vivo 2020; 34:2837-2843. [PMID: 32871822 DOI: 10.21873/invivo.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIM The efficacy and safety of early drain removal following distal pancreatectomy in elderly patients are unclear. We aimed to investigate the short-term surgical outcomes following early drain removal after distal pancreatectomy in elderly patients. PATIENTS AND METHODS Fifty-seven patients aged ≥70 years who underwent distal pancreatectomy at our Hospital were enrolled in the study. Data were retrospectively analyzed to evaluate the short-term surgical outcomes following early drain removal after distal pancreatectomy in elderly patients. RESULTS The incidence of pancreatic fistula following distal pancreatectomy in the early-removal group was significantly lower vs. the conventional group (p=0.022). Multivariate analysis revealed that early drain removal was an independent factor for reducing the risk of pancreatic fistula after distal pancreatectomy in elderly patients (p=0.042). CONCLUSION Early drain removal following distal pancreatectomy is an effective and safe surgical perioperative management procedure to prevent pancreatic fistula in elderly patients.
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Affiliation(s)
- Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yakuki Yagyu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - E I Uchinaka
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Soichiro Honjo
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
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37
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Abstract
OBJECTIVE The objectives of the current study were 2-fold: first, to evaluate the incidence and time to recovery of premorbid function within 6 months of major surgery and second, to identify factors associated with functional recovery among older persons who survive a major surgery with increased disability. BACKGROUND Most older persons would not choose a surgical treatment resulting in persistently increased postsurgical disability, even if survival was assured. Potential predictors of functional recovery after major surgery have, however, not been well-studied among geriatric patients. METHODS It is a prospective longitudinal study of 754 community-living persons 70 years or older. The analytic sample included 266 person-admissions in which participants survived major surgery with increased disability and were monitored on a monthly basis for 6 months. RESULTS Of the 266 person-admissions assessed, 174 (65.4%) recovered to their presurgical level of function, with median time to recovery of 2 months (interquartile range, 1-3), whereas 16 (6.0%) died. Two factors were significantly associated with an increased likelihood of functional recovery: being nonfrail (hazard ratio 1.60; 95% confidence interval 1.03-2.51; P = 0.038) and having elective surgery (hazard ratio 1.72; 95% confidence interval 1.14-2.59; P = 0.009). Three factors were associated with a reduced likelihood of functional recovery: hearing impairment, greater increase in postsurgical disability in the month after hospital discharge, and years of education. CONCLUSIONS Among older persons, nonfrailty and elective surgery were positively associated with functional recovery, whereas hearing impairment, greater increases in postsurgical disability, and years of education were associated with higher risk of protracted disability.
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Sasaki M, Miyoshi N, Fujino S, Ogino T, Takahashi H, Uemura M, Matsuda C, Yamamoto H, Mizushima T, Mori M, Doki Y. The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Sci Rep 2020; 10:10744. [PMID: 32612136 PMCID: PMC7329855 DOI: 10.1038/s41598-020-67285-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
Malnutrition has been considered to be associated with the prognosis of cancer. The Geriatric Nutritional Risk Index (GNRI), based on serum albumin levels, present body weight, and ideal body weight, is a simple screening tool to predict the risk of nutrition-related morbidity and mortality in elderly patients. We aimed to evaluate whether preoperative GNRI was associated with postoperative complications and prognosis in elderly patients with colorectal cancer (CRC). We retrospectively enrolled 313 CRC patients aged ≥65 years after curative surgery and classified them into an all-risk GNRI (≤98) group and a no-risk GNRI (>98) group. Kaplan-Meier analysis showed overall survival was significantly worse in the all-risk GNRI group than in the no-risk GNRI group (P = 0.009). Multivariable analyses showed low GNRI (≤98) was an independent risk factor for postoperative complications (P = 0.048) and overall survival (P = 0.001) in the patients. Among the complications, the incidence of surgical site infection, in particular, was significantly higher in the all-risk GNRI group (P = 0.008). In conclusion, low preoperative GNRI (≤98) was associated with increased postoperative complications and poor prognosis. Preoperative GNRI can be used as an identifier for potential high-risk group of morbidity and mortality in elderly CRC patients.
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Affiliation(s)
- Masaru Sasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka, Japan.
| | - Shiki Fujino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Frailty Predicts Severe Postoperative Complications After Elective Minimally Invasive Surgery in Patients with Colorectal Cancer. Indian J Surg 2020. [DOI: 10.1007/s12262-019-02001-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Lu PW, Fields AC, Yoo J, Irani J, Goldberg JE, Bleday R, Melnitchouk N. Sociodemographic predictors of surgery refusal in patients with stage I-III colon cancer. J Surg Oncol 2020; 121:1306-1313. [PMID: 32227344 DOI: 10.1002/jso.25917] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer. METHODS The National Cancer Database (2004-2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts. RESULTS A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery. After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001). CONCLUSIONS There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer.
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Affiliation(s)
- Pamela W Lu
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adam C Fields
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Yoo
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronald Bleday
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nelya Melnitchouk
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Dharmarajan K, Han L, Gahbauer EA, Leo-Summers LS, Gill TM. Disability and Recovery After Hospitalization for Medical Illness Among Community-Living Older Persons: A Prospective Cohort Study. J Am Geriatr Soc 2020; 68:486-495. [PMID: 32083319 DOI: 10.1111/jgs.16350] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine for each basic, instrumental, and mobility activity after hospitalization for acute medical illness: (1) disability prevalence immediately before and monthly for 6 months after hospitalization; (2) disability incidence 1 month after hospitalization; and (3) recovery time from incident disability during months 2 to 6 after hospitalization. DESIGN Prospective cohort study. SETTING New Haven, Connecticut. PARTICIPANTS A total of 515 community-living persons, mean age 82.7 years, hospitalized for acute noncritical medical illness and alive within 1 month of hospital discharge. MEASUREMENTS Disability was defined monthly for each basic (bathing, dressing, walking, transferring), instrumental (shopping, housework, meal preparation, taking medications, managing finances), and mobility activity (walking a quarter mile, climbing flight of stairs, lifting/carrying 10 pounds, driving) if help was needed to perform the activity or if a car was not driven in the prior month. RESULTS Disability was common 1 and 6 months after hospitalization for activities frequently involved in leaving the home to access care including walking a quarter mile (prevalence 65% and 53%, respectively) and driving (65% and 61%). Disability was also common for activities involved in self-managing chronic health conditions including meal preparation (53% and 41%) and taking medications (41% and 31%). New disability was common and often prolonged. For example, 43% had new disability walking a quarter mile, and 30% had new disability taking medications, with mean recovery time of 1.9 months and 1.7 months, respectively. Findings were similar for the subgroup of persons residing at home (ie, not in a nursing home) at the first monthly follow-up interview after hospitalization. CONCLUSION Disability in specific functional activities important to leaving home to access care and self-managing health conditions is common, often new, and present for prolonged time periods after hospitalization for acute medical illness. Post-discharge care should support patients through extended periods of vulnerability beyond the immediate transitional period. J Am Geriatr Soc 68:486-495, 2020.
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Affiliation(s)
- Kumar Dharmarajan
- Clover Health, Jersey City, New Jersey.,Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ling Han
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Evelyne A Gahbauer
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Linda S Leo-Summers
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas M Gill
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Montroni I, Ugolini G, Audisio RA. Principles of Cancer Surgery in Older Adults. GERIATRIC ONCOLOGY 2020:825-844. [DOI: 10.1007/978-3-319-57415-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Abstract
BACKGROUND Although most surgical outcomes research focuses on clinical end points and complications, older adult patients may value functional outcomes more. However, little is known about the risk of long-term functional disability after colorectal procedures. OBJECTIVE The purpose of this research was to understand the incidence and likelihood of functional decline after high-risk (ie, ≥1% inpatient mortality) colorectal operations both without and with complications. DESIGN This was a retrospective matched cohort study. SETTINGS The Health and Retirement Study, a nationally representative, longitudinal survey of adults >50 years of age, collects data on functional status, cognition, and demographics, among other topics. The survey was linked with Medicare claims and National Death Index data from 1992 to 2012. PATIENTS Patients ≥65 years of age who underwent elective high-risk colorectal surgery with functional status measured before and after surgery were included. These patients were matched 1:3 to survey respondents who did not undergo major surgery, based on propensity scores. MAIN OUTCOME MEASURES Functional decline, the primary outcome, was defined as an increase in the number of activities of daily living and instrumental activities of daily living requiring assistance before and after surgery. Using logistic regression, we examined whether surgery without or with complications was associated with functional decline. RESULTS We identified 289 patients who underwent high-risk colorectal surgery and 867 matched control subjects. Of the surgery patients, 90 (31%) experienced a complication. Compared with the control subjects, surgery patients experienced greater likelihood of functional decline (without complications: OR = 1.82 (95% CI, 1.22-2.71), and with complications: OR = 2.96 (95% CI, 1.70-5.14)). Increasing age also predicted greater odds of functional decline (OR = 2.09, per decade (95% CI, 1.57-2.80)). LIMITATIONS The functional measures were self-reported by survey participants. CONCLUSIONS High-risk colorectal surgery, without or with complications, is associated with increased likelihood of functional decline in older adults. Patient-centered decision-making should include discussion of expected functional outcomes and long-term disability. See Video Abstract at http://links.lww.com/DCR/B78. PÉRDIDA DE LA FUNCIONALIDAD A LARGO PLAZO LUEGO DE CIRUGÍA ELECTIVA COLORRECTAL DE ALTO RIESGO EN EL PACIENTE AÑOSO: Aunque en la mayoría de las investigaciones los resultados quirúrgicos se centran en los puntos finales clínicos y las complicaciones, actualmente se pueden valorar los resultados funcionales en el paciente añoso. Sin embargo, se sabe poco sobre el riesgo de la discapacidad funcional a largo plazo después de un procedimiento colorrectal.Comprender la incidencia y la probabilidad del deterioro funcional después de operaciones colorrectales de alto riesgo (es decir, ≥1% de mortalidad hospitalaria) con y sin complicaciones.Estudio de cohorte emparejado retrospectivo.El seguimiento longitudinal representativo a nivel nacional en adultos de >50 años y que recopila datos sobre su estado funcional, su estado cognitivo y su demografía, entre otros temas es el llamado "Estudio de Salud en jubilados." La encuesta se vinculó con los reclamos de Medicare y los datos del Índice Nacional de Defunciones entre 1992 y 2012.Aquellos de ≥65 años que se sometieron a cirugía colorrectal electiva de alto riesgo con un estado funcional medido antes y después de la cirugía. Estos pacientes se compararon 1: 3 con los encuestados que no se sometieron a cirugía mayor, según puntajes de propensión.La disminución functional como resultado primario, se definió como un aumento en el número de actividades de la vida diaria y actividades instrumentales de la vida diaria que requieren asistencia antes y después de la cirugía. Mediante la regresión logística, evaluamos si la cirugía sin complicaciones y/o con complicaciones se asoció con un deterioro funcional.Identificamos 289 pacientes que se sometieron a cirugía colorrectal de alto riesgo y 867 controles pareados. De los pacientes de cirugía, 90 (31%) experimentaron algun tipo de complicación. En comparación con los controles, los pacientes de cirugía experimentaron una mayor probabilidad de deterioro funcional (sin complicaciones: OR 1.82, IC 95% 1.22-2.71, y con complicaciones: OR 2.96, IC 95% 1.70-5.14). El aumento de la edad también predijo mayores probabilidades en el deterioro funcional (OR 2.09, por década, IC 95% 1.57-2.80).Las medidas funcionales fueron autoinformadas por los participantes de la encuesta.La cirugía colorrectal de alto riesgo, con o sin complicaciones, se asocia con una mayor probabilidad de deterioro funcional en adultos mayores. La toma de decisiones centradas en el paciente deben incluir la discusión de los resultados funcionales esperados y la discapacidad a largo plazo. Vea el resumen del video en http://links.lww.com/DCR/B78.
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Mehaffey JH, Hawkins RB, Charles EJ, Kron IL, Ailawadi G, Kern JA, Roeser ME, Kozower B, Teman NR. Impact of Complications After Cardiac Operation on One-Year Patient-Reported Outcomes. Ann Thorac Surg 2020; 109:43-48. [DOI: 10.1016/j.athoracsur.2019.05.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
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Giannotti C, Sambuceti S, Signori A, Ballestrero A, Murialdo R, Romairone E, Scabini S, Caffa I, Odetti P, Nencioni A, Monacelli F. Frailty assessment in elective gastrointestinal oncogeriatric surgery: Predictors of one-year mortality and functional status. J Geriatr Oncol 2019; 10:716-723. [DOI: 10.1016/j.jgo.2019.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 12/11/2022]
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Dementia in elderly patients undergoing early cholecystectomy for acute cholecystitis: a retrospective observational study. BMC Surg 2019; 19:71. [PMID: 31262275 PMCID: PMC6604413 DOI: 10.1186/s12893-019-0548-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background Dementia often adversely affects postoperative outcomes in surgical patients. This study evaluated postoperative outcomes among elderly patients with and without dementia undergoing early cholecystectomy for acute cholecystitis (AC). Methods A total of 182 patients over 85 years of age who were diagnosed with AC and treated from January 2005 to March 2018 were reviewed retrospectively; 59 patients who underwent early cholecystectomy were enrolled. The complication rates, length of postoperative hospital stay, and rates of routine discharge (i.e., returning to their preoperative living location) were compared between two groups of patients with and without dementia. Results The overall complication rate after early cholecystectomy for AC in 59 patients was 11.9%, and there was no mortality in this series. The median postoperative hospital stay was 9.0 days, and the routine discharge rate was 89.8%. Of the 59 patients, 22 patients (37.3%) had a history of dementia. Complication rates were comparable between the groups, despite the rate of delirium development being significantly higher in the dementia group. The median length of postoperative hospital stay and routine discharge rates did not significantly differ between groups. Conclusions Early cholecystectomy for patients with AC over 85 years of age was performed safely, and elderly patients with dementia had similar postoperative outcomes as compared with patients without dementia.
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Short-term postoperative physical decline and patient-reported recovery in people aged 70 or older undergoing abdominal cancer resection– A prospective cohort study. J Geriatr Oncol 2019; 10:610-617. [DOI: 10.1016/j.jgo.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/23/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023]
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Nomi T, Hirokawa F, Kaibori M, Ueno M, Tanaka S, Hokuto D, Noda T, Nakai T, Ikoma H, Iida H, Komeda K, Ishizaki M, Hayami S, Eguchi H, Matsumoto M, Morimura R, Maehira H, Sho M, Kubo S. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a multi-centre propensity score-based analysis. Surg Endosc 2019; 34:658-666. [PMID: 31093748 DOI: 10.1007/s00464-019-06812-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The frequency of liver resection in elderly patients has been increasing. However, data are limited regarding the safety of laparoscopic liver resection (LLR) compared with that of open liver resection (OLR) for hepatocellular carcinoma (HCC) in elderly patients. The present study aimed to compare short-term outcomes between LLR and OLR in elderly patients with HCC using propensity score matching. METHODS The study included 630 patients (age, ≥ 75 years) who underwent liver resection for HCC at nine liver centres between April 2010 and December 2017. Patients were divided into LLR and OLR groups, and perioperative outcomes were compared between the groups. In addition, subgroup analysis was performed according to age (75-79 and ≥ 80 years). RESULTS Of the 630 patients, 221 and 409 were included in the LLR and OLR groups, respectively. After propensity score matching, 155 patients were included in each group. Intraoperative blood loss and the transfusion, post-operative overall complication and major complication rates were lower in the matched LLR than the matched OLR group (P < 0.001, P = 0.004, P < 0.001 and P < 0.001, respectively). Moreover, post-operative pulmonary and cardiovascular complications were less frequent in the matched LLR group (P = 0.008 and P = 0.014, respectively). In subgroup analysis, among octogenarians, the post-operative major complication rate was lower and hospital stay was shorter in the matched LLR than the matched OLR group (P < 0.001 and P < 0.001, respectively). CONCLUSION LLR for HCC is associated with good short-term outcomes in patients aged ≥ 75 years compared with OLR. LLR is safe and feasible in selected octogenarians with HCC.
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Affiliation(s)
- Takeo Nomi
- Department of Surgery, Nara Medical University, 840, Shijocho, Kashihara, Nara, 634-8522, Japan.
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaki Kaibori
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, 840, Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroya Iida
- Division of Gastrointestinal, Breast, and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga Prefecture, Japan
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Morihiko Ishizaki
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shinya Hayami
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masataka Matsumoto
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiromitsu Maehira
- Division of Gastrointestinal, Breast, and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga Prefecture, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840, Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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The impact of colorectal surgery on health-related quality of life in older functionally dependent patients with cancer - A longitudinal follow-up study. J Geriatr Oncol 2019; 10:724-732. [PMID: 31076314 DOI: 10.1016/j.jgo.2019.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Older patients who are functionally compromised or frail may be at risk for loss of quality of life (QoL) after colorectal cancer (CRC) surgery. We prospectively studied health-related QoL (HRQoL) and its association with functional dependency on multiple time points before and after CRC surgery. METHODS Included were patients aged 70 years and older who underwent elective CRC surgery between 2014 and 2015 in combination with an oncogeriatric care path. HRQoL (EORTC QLQ-C30 and CR38) and activities of daily living (ADL, Barthel Index) were measured at four time-points; prior to (T0) and at 3 (T3), 6 (T6), and 12 (T12) months after surgery. Functional dependency was defined as a Barthel Index <19. Using mixed-model regression analysis associations between dependency, time and HRQoL outcomes were tested and corrected for confounders. RESULTS Response rate was 67% (n = 106) to two or more questionnaires; 26 (25%) patients were functionally dependent. Overall, functionally independent patients experienced a higher HRQoL than dependent patients. Compared to T0, significant and clinically relevant improvements in HRQoL after surgery were observed in functionally dependent patients: better role functioning, a higher global health, a higher summary score, less fatigue and less gastrointestinal problems (p < .05). In functional independent patients, we observed no clinically relevant change in HRQoL. CONCLUSION Colorectal surgery embedded in geriatric-oncological care has a positive impact on HRQoL in older functionally dependent patients with cancer. Moderate functional dependency should not be considered a generic reason for withholding surgical treatment. Information derived from this study could be used in shared decision making.
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Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg 2019; 217:677-681. [DOI: 10.1016/j.amjsurg.2018.07.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/04/2018] [Accepted: 07/08/2018] [Indexed: 12/29/2022]
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