The impact of colorectal surgery on health-related quality of life in older functionally dependent patients with cancer: A longitudinal follow-up study

Esteban T.D. Souwer*, Simone Oerlemans, Lonneke V. van de Poll-Franse, Felice N. Van Erning, Frederiek Van Den Bos, Johan S. Schuijtemaker, Franchette W.P.J. Van Den Berkmortel, Daan Ten Bokkel Huinink, Marije E. Hamaker, Jan Willem T. Dekker, Caroline A. Wientjes, Johanna E.A. Portielje, Huub A.A. Maas

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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.
Original languageEnglish
Pages (from-to)724-732
JournalJournal of Geriatric Oncology
Volume10
Issue number5
DOIs
Publication statusPublished - 2019

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Keywords

  • 1ST YEAR
  • Aged
  • CARE
  • COLON-CANCER
  • Colorectal neoplasms
  • ELECTIVE SURGERY
  • EUROPEAN-ORGANIZATION
  • FRAIL PATIENTS
  • Health related quality of life
  • INSTRUMENT
  • Longitudinal study
  • OUTCOMES
  • RECTAL-CANCER
  • RESECTION
  • Surgery

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