Most Older Patients Report Functional Recovery Following Colorectal Cancer Surgery

Isacco Montroni, MD, PhD

Most older patients achieved functional recovery (FR) 3 months after their major colorectal cancer surgery, according to findings from the Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE; NCT03299270) study, published in the Journal of Clinical Oncology.

Overall, 78.6% of patients with colon cancer (n = 323) and 70.6% of patients with rectal cancer (n = 133) reported FR after 3 months.

Certain risk factors were associated with worse postoperative outcomes. For patients with colon cancer, a Charlson Age Comorbidity Index of at least 7 (OR, 2.59; 95% CI, 1.26-5.32; P = .009), an ECOG performance status (PS) of 2 or more (OR, 3.12; 95% CI, 1.36-7.20; P = .007) were less likely to achieve FR by 3 months.

Patients who experienced severe complications were less likely to achieve FR by 3 months (OR, 12.86; 95% CI, 4.67-35.44; P < .001) or 6 months (OR, 10.32; 95% CI, 3.76-28.33; P < .00). At 6 months, patients with colon cancer who had a baseline score Flemish version of the Triage Risk Screening Test (fTRST) score of at least 2 (OR, 2.71; 95% CI, 1.40-5.25; P = .003) or who require palliative colonic surgery (OR, 4.11; 95% CI, 1.29 to 13.07; P = .017) had a lower chance of achieving FR.

For patients with rectal cancer, a preoperative ECOG PS equal to 2 or more decreased the likelihood of FR by 6 months (OR, 4.61; 95% CI, 1.45-14.63; P = .009).

“This demonstrates, together with the patients’ ability to maintain their function in most cases, that older patients can undergo potentially curative major cancer surgery without compromising an important priority: remaining independent,” Isacco Montroni, MD, PhD, of the Department of Surgery at the Hospital Santa Maria delle Croci, and co-investigators, wrote in the study.

Investigators collected prospective data from 625 patients; 435 of whom had colon cancer and 190 patients of whom had rectal cancer. These patients were all 70 years or older and were about to undergo major elective colorectal surgery. These patients were assessed for frailty and quality of life (QOL) at 3 months and 6 months postoperatively. Investigators used the EuroQol-5 Dimension to assess QOL.

This study was conducted across 26 hospitals from multiple countries between February 2017 and April 2019. At baseline, 9.8% of patients had moderate to severe malnutrition and 23.3% had cognitive impairment.

Among evaluable patients, 52.6% were men, and the median patient age was 79.0 years (IQR, 74.6-82.9). For 73% of patients, the surgery was minimally invasive.

The study parameters measured postoperative FR through 3 variables: independence in the Activity of Daily Living (ADL), the Timed Up & Go (TUG) Test, and the MiniCog greater than 2. Patients were determined to have achieved FR if their ADL score was at least 5, their TUG test time was under 20 seconds, and their MiniCog scores were greater than 2.

The study’s primary end point was to compare patient QOL before and after surgery. The study’s secondary objectives were to determine if patients achieved FR, and which risk factors were associated with FR and QOL.

At 3 months and 6 months postoperative follow-up, 68.9% and 70.3% of patients reported improved QOL.

A logistic regression analysis revealed that patients who had a fTRST score of 2 or higher prior to surgery were at risk for worse QOL following a colectomy at both 3 months (OR, 1.68; 95% CI, 1.04-2.73; P = .034) and 6 months of follow-up (OR, 1.71; 95% CI, 1.06 to 2.75; P = .027).

Similarly, patients with postoperative complications were more likely to have decreases in QOL following colectomy at both 3 months (OR, 2.03; 95% CI, 1.20 to 3.42; P = .008) and 6 months of follow-up (OR, 2.56; 95% CI, 1.15 to 5.68; P = .02).

For patients with rectal cancer, an ECOG PS greater than 2 was associated with greater postoperative decline in QOL (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006).

"Frailty screening tools, history of delirium, and postoperative complications correlate with a worse QOL and FR,” study authors concluded. “These items and their correlation with the restoration of QOL and function should guide the conversation about possible surgical strategies.”

Reference

Montroni I, Ugolini G, Saur NM, et al. Predicting functional recovery and quality of life in older patients undergoing colorectal cancer surgery: real-world data from the international GOSAFE study. J Clin Oncol. Published online June 30, 2023. doi:10.1200/JCO.22.02195