Ann Surg Treat Res.  2022 Sep;103(3):169-175. 10.4174/astr.2022.103.3.169.

Efficacy of geriatric multidisciplinary oncology clinic in the surgical treatment decision-making process for frail elderly patients with colorectal cancer

• Yang IJ
• Oh HK
• Lee J
• Suh JW
• Ahn HM
• Shin HR
• Kim JW
• Kim JH
• Song C
• Choi JY
• Kim DW
• Kang SB

• KMID: 2532929
• DOI: http://doi.org/10.4174/astr.2022.103.3.169

Abstract

Purpose
Multidisciplinary care has become a cornerstone of colorectal cancer management. To evaluate the clinical efficacy of a geriatric multidisciplinary oncology clinic (GMOC), we analyzed the surgical treatment decision-making process and outcomes.
Methods
This retrospective single-center study reviewed the data of patients aged ≥65 years who participated in the GMOC at a tertiary referral hospital between 2015 and 2021. The clinical adherence rate, comprehensive geriatric assessment, and a multidimensional frailty score (MFS) were obtained. The groups that were recommended and not recommended for surgery were compared, analyzing the factors impacting the decision and 1-year survival outcomes. Furthermore, the postoperative complications of patients who underwent surgery were evaluated.
Results
A total of 165 patients visited the GMOC, and 74 had colorectal cancer (mean age, 85.5 years [range, 81.2–89.0 years]). Among patients with systemic disease (n = 31), 7 were recommended for surgery, and 5 underwent surgery. Among patients with locoregional disease (n = 43), 18 were recommended for surgery, and 12 underwent surgery. Patients recommended and not recommended for surgery had significantly different activities of daily living (ADL) (P = 0.024), instrumental ADL (P = 0.001), Mini-Mental State Examination (P = 0.014), delirium risk (P = 0.039), and MFS (P = 0.001). There was no difference in the 1-year overall survival between the 2 groups (P = 0.980). Of the 17 patients who underwent surgery, the median (interquartile range) of operation time was 165.0 minutes (120.0–270.0 minutes); hospital stay, 7.0 days (6.0–8.0 days); and 3 patients had wound complications.
Conclusion
Proper counseling of patients through the GMOC could lead to appropriate management and favorable outcomes.

Keyword

Colorectal neoplasms; Colorectal surgery; Frail elderly; Geriatric assessment; Patient care team

Figure

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  Fig. 1 Flow of clinical decision process. In all patients, the clinical adherence rate to the medical recommendation was 40.5% (30 of 74). GMOC, geriatric multidisciplinary oncology clinic; neoadj, neoadjuvant; Tx, therapy; CTx, chemotherapy; RTx, radiotherapy.

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  Fig. 2 The overall survival (OS) of 1 year in recommended and actual operation groups. (A) According to recommended for operation (n = 32). (B) According to actual operation (n = 18).

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