title: Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study.
abstract: BACKGROUND
  A number of elderly cancer patients do not receive standard surgery for solid tumors because they are considered unfit for treatment as a consequence of inaccurate estimation of the operative risk. To tailor treatment to onco-geriatric series, oncologists are now beginning to use a comprehensive geriatric assessment (CGA). This study investigates the value of an extended CGA in assessing the suitability of elderly patients for surgical intervention.
  
  
  METHODS
  Preoperative assessment of cancer in the elderly (PACE) incorporates validated instruments including the CGA, an assessment of fatigue and performance status and an anaesthesiologist's evaluation of operative risk. An international prospective study was conducted using 460 consecutively recruited elderly cancer patients who received PACE prior to elective surgery. Mortality, post-operative complications (morbidity) and length of hospital stay were recorded up to 30 days after surgery.
  
  
  RESULTS
  Poor health in relation to disability (assessed using the instrumental activities of daily living (IADL)), fatigue and performance status (PS) were associated with a 50% increase in the relative risk of post-operative complications. Multivariate analysis identified moderate/severe fatigue, a dependent IADL and an abnormal PS as the most important independent predictors of post-surgical complications. Disability assessed by activities of daily living (ADL), IADL and PS were associated with an extended hospital stay.
  
  
  CONCLUSIONS
  PACE represents a valuable tool in enhancing the decision process concerning the candidacy of elderly cancer patients for surgical intervention and can reduce inappropriate age-related inequity in access to surgical intervention. It is recommended that PACE be used routinely in surgical practice.
authors: raudisio@doctors.org.uk
authors: R A
authors: RA
authors: Audisio
authors: D
authors: D
authors: Pope
authors: H S J
authors: HS
authors: Ramesh
authors: R
authors: R
authors: Gennari
authors: B L
authors: BL
authors: van Leeuwen
authors: C
authors: C
authors: West
authors: G
authors: G
authors: Corsini
authors: M
authors: M
authors: Maffezzini
authors: H J
authors: HJ
authors: Hoekstra
authors: D
authors: D
authors: Mobarak
authors: F
authors: F
authors: Bozzetti
authors: M
authors: M
authors: Colledan
authors: H
authors: H
authors: Wildiers
authors: A
authors: A
authors: Stotter
authors: A
authors: A
authors: Capewell
authors: E
authors: E
authors: Marshall
mesh_terms: D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D015996:Survival Rate