TY - JOUR
T1 - The impact of colorectal surgery on health-related quality of life in older functionally dependent patients with cancer - A longitudinal follow-up study
AU - Souwer, Esteban T D
AU - Oerlemans, Simone
AU - van de Poll-Franse, Lonneke V
AU - van Erning, Felice N
AU - van den Bos, Frederiek
AU - Schuijtemaker, Johan S
AU - van den Berkmortel, Franchette W P J
AU - Ten Bokkel Huinink, Daan
AU - Hamaker, Marije E
AU - Dekker, Jan Willem T
AU - Wientjes, Caroline A
AU - Portielje, Johanna E A
AU - Maas, Huub A A
N1 - Copyright © 2019 Elsevier Inc. All rights reserved.
PY - 2019/9
Y1 - 2019/9
N2 - 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.
AB - 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.
KW - Colorectal neoplasms
KW - Surgery
KW - Aged
KW - Health related quality of life
KW - Longitudinal study
UR - http://www.scopus.com/inward/record.url?scp=85065164301&partnerID=8YFLogxK
U2 - 10.1016/j.jgo.2019.04.013
DO - 10.1016/j.jgo.2019.04.013
M3 - Article
C2 - 31076314
SN - 1879-4068
VL - 10
SP - 724
EP - 732
JO - Journal of geriatric oncology
JF - Journal of geriatric oncology
IS - 5
ER -