title: Independence and health related quality of life in 200 onco-geriatric surgical patients within 6 months of follow-up: Who is at risk to lose?
abstract: OBJECTIVE
  Comprehensive Geriatric Assessment (CGA) provides information on aspects of older patients to predict risks and benefits of interventions.
  
  
  METHODS
  To evaluate the application of CGA (including quality of life (QOL)) for the risk prediction of postoperative dependence and QOL in elderly patients with malignant tumours, a prospective observational study including 200 patients >70 years was performed. The primary outcome was postoperative activities of daily living (ADL < 95), secondary outcome was QOL at 6 months. Multivariate regression was performed to assess the impact of associated factors (socio-demographic, clinical, functional, cognitive variables, resilience, and EORTC-QLQ-C30 QOL).
  
  
  RESULTS
  Median age of patients was 75 (70-88) years with 69% males. The majority of operations was for colon carcinoma; morbidity was 24.8%, mortality 1.5%. Impairment in ADL (<95) affected 6.7% (13/195) pre-, and 9.7% (12/124) post-operatively. Analyzing factors predicting loss of ADL, the following reached significance: BMI (OR: 1.7; p = 0.019), ADL (OR: 0.67; p = 0.0317), and of the QLQ-C30: diarrhea (OR: 1.04; p = 0.013), emotional functioning (OR: 0.91; p = 0.0242), physical functioning (OR: 0.92; p = 0.027). QOL paralleled ADL (pre-op: 65.4 to 67 postoperatively, respectively); predictive were: Karnofsky Index (Parameter Estimate (PE): 0.55; p = 0.0003) and (QLQ-C30) emotional functioning (PE: 0.14; p = 0.0208).
  
  
  CONCLUSIONS
  Those considered for oncologic surgery can be assured that few lose independence. CGA/QOL highlight signs of vulnerability and options for pre-habilitation. Registries including a minimal CGA data set will make pre-selections reproducible and objectify risk/benefit estimations - relevant for those withheld from potentially curative surgery.
authors: University of Freiburg Surgical Department, Freiburg, Germany; Caritas Krankenhaus Bad Mergentheim, Germany.
authors: P
authors: P
authors: Baier
authors: Clinical Trials Unit, University of Freiburg Medical Center, Freiburg, Germany.
authors: G
authors: G
authors: Ihorst
authors: University of Freiburg Surgical Department, Freiburg, Germany.
authors: G
authors: G
authors: Wolff-Vorbeck
authors: Gerontopsychiatrie Emmendingen, Germany.
authors: M
authors: M
authors: Hüll
authors: University of Freiburg Surgical Department, Freiburg, Germany.
authors: U
authors: U
authors: Hopt
authors: Comprehensive Cancer Center Mainfranken, Würzburg, Germany. Electronic address: deschler_b@ukw.de.
authors: B
authors: B
authors: Deschler
mesh_terms: D000203:Activities of Daily Living; D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D003967:Diarrhea / Q000453:epidemiology; D004067:Digestive System Neoplasms / Q000453:epidemiology / Q000601:surgery*; D004644:Emotions; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D057187:Independent Living; D017567:Karnofsky Performance Status; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D018570:Risk Assessment
keywords: Cancer; Geriatric assessment; Quality of life; Surgery