title: Frailty is an independent predictor of survival in older patients with colorectal cancer.
abstract: BACKGROUND
  Colorectal cancer (CRC) is prevalent in the older population. Geriatric assessment (GA) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients. The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors (TNM) stage and age.
  
  
  METHODS
  A cohort of 178 CRC patients aged 70 and older were followed prospectively. All patients went through elective surgery, and GA was performed presurgery. The GA resulted in patients being divided into two groups: frail or nonfrail. All patients were followed for 5 years or until death. Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model.
  
  
  RESULTS
  Seventy-six patients (43%) were frail, and one hundred and two (57%) were nonfrail. Twenty-three patients (13%) died during the first year after surgery. One-year survival was 80% in the frail group and 92% in the nonfrail group. Five-year survival was significantly lower in frail (24%) than nonfrail patients (66%), and this difference was apparent both within the stratums of TNM stages 0-II and TNM stage III. In multivariable analysis adjusting for TNM stage, age, and sex, frailty was an independent prognostic factor for survival.
  
  
  CONCLUSIONS
  A GA-based frailty assessment predicts 1-year and 5-year survival in older patients after surgery for CRC. In localized and regional disease, the impact of frailty upon 5-year survival is comparable with that of TNM stage.
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway ninaommundsen@gmail.com.
authors.forename: Nina
authors.initials: N
authors.lastname: Ommundsen
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway.
authors.forename: Torgeir B
authors.initials: TB
authors.lastname: Wyller
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway.
authors.forename: Arild
authors.initials: A
authors.lastname: Nesbakken
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway.
authors.forename: Marit S
authors.initials: MS
authors.lastname: Jordhøy
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Bakka
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Skovlund
authors.affiliation: Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Rostoft
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D063189:Symptom Assessment
keywords: Colorectal neoplasms; Frail elderly; Geriatric assessment; Mortality