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

Montroni, Isacco; Saur, Nicole M.; Shahrokni, Armin; Suwanabol, Pasithorn A.; Chesney, Tyler R.

doi:10.1200/jco.21.00143

Cited by 27 publications

(32 citation statements)

References 98 publications

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“…Various frailty instruments that can be used at the point of care for screening are available and have been shown to be accurate, feasible, and easily integrated in routine clinical practice and workflow. [77][78][79][80] Of note, the differences in long-term outcomes between patients with and without frailty should not lead to the conclusion that surgery is not indicated or is not worth the risk in the presence of frailty. Rather, acknowledgment of frailtyspecific risks should allow an individualized, patient-centered discussion with patients to determine whether surgery is indicated and desired.…”

Section: Discussionmentioning

confidence: 99%

Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis

Hallet

Tillman

Zuckerman

et al. 2022

Journal of the National Comprehensive Cancer Network

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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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Section: Discussionmentioning

confidence: 99%

Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis

Hallet

Tillman

Zuckerman

et al. 2022

Journal of the National Comprehensive Cancer Network

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“…There remains a need to pursue the implementation of geriatric assessment in routine surgery practice and to improve the subsequent geriatric care. This approach should aim to define how pre‐operative geriatric assessment can guide the use of minimally invasive approaches and, when combined with tailored recovery protocols, how this assessment can reduce surgical stress and promote functional recovery [108].…”

Section: Improving the Treatment Of Established Cancers In Ageing Pat...mentioning

confidence: 99%

Ageing and cancer: a research gap to fill

2022

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The complex mechanisms of ageing biology are increasingly understood. Interventions to reduce or delay ageing-associated diseases are emerging. Cancer is one of the diseases promoted by tissue ageing. A clockwise mutational signature is identified in many tumours. Ageing might be a modifiable cancer risk factor. To reduce the incidence of ageing-related cancer and to detect the disease at earlier stages, we need to understand better the links between ageing and tumours. When a cancer is established, geriatric assessment and measures of biological age might help to generate evidencebased therapeutic recommendations. In this approach, patients and caregivers would include the respective weight to give to the quality of life and survival in the therapeutic choices. The increasing burden of cancer in older patients requires new generations of researchers and geriatric oncologists to be trained, to properly address disease complexity in a multidisciplinary manner, and to reduce health inequities in this population of patients. In this review, we propose a series of research challenges to tackle in the next few years to better prevent, detect and treat cancer in older patients while preserving their quality of life.

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“…On the bright side, this study addresses an important question about the longterm probability of not living at home after surgery, which is an important matter for older adults who benefit from personalized care. 6 Also important to highlight is that this study was well constructed and involved a large population that included multiple cancer types from comprehensive databases available in Ontario, Canada. A previous study from this same group with a similar population showed that 5 years after surgical resection for cancer, 20% of patients died of cancer and 16% died of other causes.…”

Section: See Page 1223 For Related Articlementioning

confidence: 99%

“…Surgical intervention is safe and can have a positive impact on older adults with adequate risk stratification. 6 But this is definitely not the case for vulnerable or frail patients who are at high risk of experiencing complications and death in the postoperative period.…”

Section: See Page 1223 For Related Articlementioning

confidence: 99%

Frailty After Cancer Surgery Among Older Adults: A Geriatric Oncology Perspective

Dubé¹,

Alibhai²

2022

Journal of the National Comprehensive Cancer Network

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

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 27 publications

References 98 publications

Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis

Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis

Ageing and cancer: a research gap to fill

Frailty After Cancer Surgery Among Older Adults: A Geriatric Oncology Perspective

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