Abstract
Background
Treating elderly colorectal cancer patients can be challenging. It is very important to carefully weigh the risks and benefits of potential treatments in individual patients. This treatment decision making can be guided by geriatric consultation. Our aim was to assess the effect of a geriatric evaluation on treatment decisions for older patients with colorectal cancer.
Methods
Colorectal cancer patients who were referred for a geriatric consultation between 2013 and 2015 in three Dutch teaching hospitals were included in a prospective database. The outcome of geriatric assessment, non-oncological interventions and geriatricians’ treatment recommendations were evaluated.
Results
The total number of included referrals was 168. The median age was 81 years (range 60–94). Most patients (71%) had colon cancer and 49% had tumour stage III disease. The reason for geriatric consultation was uncertainty regarding the optimal oncologic treatment in 139 patients (83%). Overall 93% of patients suffered from geriatric impairments; non-oncological interventions that followed after geriatric consultation was mostly aimed at malnutrition. The geriatrician recommended the ‘more intensive treatment’ option in 69% and the ‘less intensive treatment’ option in 31% of which 63% ‘supportive care only’.
Conclusion
Geriatric consultation can be useful in treatment decision making in elderly patients with colorectal cancer. It may lead to changes in the treatment plan for individual cases and may result in an additional optimisation of patient’s health status prior to treatment.
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References
Verweij NM, Schiphorst AH, Maas HA, Zimmerman DD, van den Bos F, Pronk A, Borel Rinkes IHM, Hamaker ME (2016) Colorectal cancer resections in the oldest old between 2011 and 2012 in The Netherlands. Ann Surg Oncol 23(6):1875–1882
Dekker JW, van den Broek CB, Bastiaannet E et al (2011) Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol 18(6):1533–1539
Hamaker ME, Prins MC, Schiphorst AH et al (2015) Long-term changes in physical capacity after colorectal cancer treatment. J Geriatr Oncol 6(2):153–164
Hamaker ME, Prins MC, Stauder R (2014) The relevance of a geriatric assessment for elderly patients with a haematological malignancy: a systematic review. Leuk Res 38:275–283
Wildiers H, Heeren P, Puts M et al (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32:2595–2603
Extermann M, Aapro M, Bernabei R et al (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55:241–252
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
Netherlands Cancer registry (2016) www.cijfersoverkanker.nl. Accessed 1 Sept 2016
Verweij NM, Schiphorst AHW, Pronk A et al (2016) Physical performance measures for predicting outcome in cancer patients: a systematic review. Acta Oncol 8:1–6
Brunello A, Sandri R, Extermann M (2009) Multidimensional geriatric evaluation for older cancer patients as a clinical and research tool. Cancer Treat Rev 35:487–492
Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25:1824–1831
Verweij NM, Hamaker ME, Zimmerman DDE et al (2017) The impact of an ostomy on older colorectal cancer patients: a cross-sectional survey. Int J Colorectal Dis 32(1):89–94
Reynolds J, Chamberland-Tremblay A, Herrington JD et al (2017) High- versus low-dose leucovorin in the modified FOLFOX6 regimen for first-line treatment of metastatic colorectal cancer. J Oncol Pharm Pract 23(3):173–178
Lai P, Sud S, Zhang T et al (2016) Palliative chemotherapy in advanced colorectal cancer patients 80 years of age and older. Curr Oncol 23(3):144–153
Hamaker ME, Schiphorst AH, ten Bokkel HD, Schaar C, van Munster BC (2014) The effect of a geriatric evaluation on treatment decisions for older cancer patients—a systematic review. Acta Oncol 53(3):289–296
Verweij NM, Schiphorst AHW, Pronk A et al (2015) Conventional and laparoscopic colon resections in the elderly. World J Color Surg 5(2):Article 3
Puts M, Sattar S, McWatters K et al A feasibility trial of geriatric assessment and integrated care plan for older cancer patients. Abstract 2016 SIOG conference, Milan. DOI: 10.1016/S1879-4068(16)30161-8
Li D, Kelly C, Trent M et al A randomized controlled trial of geriatric assessment guided multidisciplinary interventions: the first year experience. Abstract 2016 SIOG conference, Milan DOI: 10.1016/S1879-4068(16)30162-X
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N. M. Verweij: Study design, interpretation of data, wrote the paper and approved the final version. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
E. T. D. Souwer, H. A. Maas, J. E. A. Portielje, A. Pronk, F. van den Bos: Study design, revising and approved the final version. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
A. H. W. Schiphorst, M. E. Hamaker: Study design, interpretation of data, revising and approved the final version. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Financial support
This study was supported by the Aart Huisman Scholarship for research in geriatric oncology and the Cornelis Visser Foundation.
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Verweij, N.M., Souwer, E.T.D., Schiphorst, A.H.W. et al. The effect of a geriatric evaluation on treatment decisions for older patients with colorectal cancer. Int J Colorectal Dis 32, 1625–1629 (2017). https://doi.org/10.1007/s00384-017-2883-8
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DOI: https://doi.org/10.1007/s00384-017-2883-8