Outcomes that matter to patients: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study—Analysis of 471 patients.

Abstract

11511 Background: Older cancer patients value functional outcomes as much as survival but surgical studies lack functional recovery (FR) data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ quality of life (QoL)and FR after cancer surgery and to assess predictors of FR. Methods: GOSAFE prospectively collects functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes are recorded (30 days, 90 days, and 180 dayspost-operatively) with QoL(EQ-5D-3L) and FR (Activities of Daily Living (ADL) + Timed Up and Go (TUG) + MiniCog), 28centers are prospectively enrolling patients; accrual ends February 2019. Results: 643 patients underwent major cancer surgery with curative(94%) or palliative (6%) intent (February 2017-September 2018). Median age was 78(range 70-94); 51.6% males, ASA III-IV 52%. Patients dependent (ADL < 5) were 8%. Frailty was detected by G8 > 14 in 32% and fTRST≥2 in 36% of patients. 639 (99%) lived at home, 32% lived alone, and 88% were able to go out. Major comorbidities (CCI > 6) were detected in 36% and 22% had cognitive impairment according to MiniCog (5% self-reported). 26% had > 3 kg weight loss, 30% were hospitalized in the last 90 days, 45% had ≥3 medications (6% none). For 471 patients, a 90-day comprehensive evaluation was available. Postoperative morbidity was 42% (30 day) and 63.3% (90 day), but Clavien-Dindo III-IV complications were only 11.2% and 17.6%. 90-day mortality was 7.4% (5% 30-day). QoL improved 90 days after surgery (mean EQ-5D index from 0.76 to 0.80). Patients with EQ-5D VAS score > 60 raised from 73.9% at baseline to 82.8% at 90 days. 29% had complete FR (ADL score > 4, MiniCog > 2, TUG < 20). Decreased functional capacity was seen in 23.4% of patients alive at 90-days. Conclusions: GOSAFE is the largest prospective study on older cancer patients undergoing major surgery. Interim analysis reports decreased functional capacity in a quarter of patients. The study will allow clinicians to associate clinical outcomes with individual factors of the preoperative assessment and create a user-friendly tool to predict outcomes that matter to patients.

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

“…The Barthel index was used to evaluate the ADLs (100 points indicated independent ADLs). As mentioned above, patients undergoing tumour resection were assumed to have a high level of preoperative ADL independence 4. For these patients, the need for any assistance after surgery, even if temporary, can impair their quality of life.…”

“…There is no standard age limit for patients to undergo surgery, as long as they can tolerate invasive procedures. A previous study reported that >90% of older patients undergoing tumour resection were independent in terms of their activities of daily living (ADLs) before surgery 4…”

Frailty Assessment and Prehabilitation as Part of a PeRioperative Evaluation and Planning (PREP) Program for Patients Undergoing Colorectal Surgery

“…45 Cognitive impairment, again measured by the Mini-Cog, was also observed in 21% of 1,003 patients older than 70 years before undergoing major elective oncologic surgery in the prospective, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study. 46 A compelling reason to evaluate for cog-nitive impairment preoperatively is to predict and prepare patients and caregivers for the likelihood of postoperative delirium as preoperative cognitive impairment is one of the strongest predictors of postoperative delirium. 47 Also, importantly, delirium can be prevented in up to 50% of patients by utilizing a delirium prevention bundle.…”

Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care

“…Evaluating success in surgical cancer care among older adults must go beyond survival, cancer control, and early postoperative outcomes to include disability, change in quality of life, and maintenance of function with particular attention to patient preferences. [13][14][15] Overall, these outcomes are important for the broader goal of recovery for older adults, which we refer to as functional recovery.…”