Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study.
Journal
Journal of the National Cancer Institute
ISSN: 1460-2105
Titre abrégé: J Natl Cancer Inst
Pays: United States
ID NLM: 7503089
Informations de publication
Date de publication:
11 07 2022
11 07 2022
Historique:
received:
19
10
2021
revised:
11
01
2022
accepted:
23
03
2022
pubmed:
9
4
2022
medline:
15
7
2022
entrez:
8
4
2022
Statut:
ppublish
Résumé
Accurate quality of life (QoL) data and functional results after cancer surgery are lacking for older patients. The international, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) Study compares QoL before and after surgery and identifies predictors of decline in QoL. GOSAFE prospectively collected data before and after major elective cancer surgery on older adults (≥70 years). Frailty assessment was performed and postoperative outcomes recorded (30, 90, and 180 days postoperatively) together with QoL data by means of the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L), including 2 components: an index (range = 0-1) generated by 5 domains (mobility, self-care, ability to perform the usual activities, pain or discomfort, anxiety or depression) and a visual analog scale. Data from 26 centers were collected (February 2017-March 2019). Complete data were available for 942/1005 consecutive patients (94.0%): 492 male (52.2%), median age 78 years (range = 70-95 years), and primary tumor was colorectal in 67.8%. A total 61.2% of all surgeries were via a minimally invasive approach. The 30-, 90-, and 180-day mortality was 3.7%, 6.3%, and 9%, respectively. At 30 and 180 days, postoperative morbidity was 39.2% and 52.4%, respectively, and Clavien-Dindo III-IV complications were 13.5% and 18.7%, respectively. The mean EQ-5D-3L index was similar before vs 3 months but improved at 6 months (0.79 vs 0.82; P < .001). Domains showing improvement were pain and anxiety or depression. A Flemish Triage Risk Screening Tool score greater than or equal to 2 (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.13 to 2.21, P = .007), palliative surgery (OR = 2.14, 95% CI = 1.01 to 4.52, P = .046), postoperative complications (OR = 1.95, 95% CI = 1.19 to 3.18, P = .007) correlated with worsening QoL. GOSAFE shows that older adults' preoperative QoL is preserved 3 months after cancer surgery, independent of their age. Frailty screening tools, patient-reported outcomes, and goals-of-care discussions can guide decisions to pursue surgery and direct patients' expectations.
Sections du résumé
BACKGROUND
Accurate quality of life (QoL) data and functional results after cancer surgery are lacking for older patients. The international, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) Study compares QoL before and after surgery and identifies predictors of decline in QoL.
METHODS
GOSAFE prospectively collected data before and after major elective cancer surgery on older adults (≥70 years). Frailty assessment was performed and postoperative outcomes recorded (30, 90, and 180 days postoperatively) together with QoL data by means of the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L), including 2 components: an index (range = 0-1) generated by 5 domains (mobility, self-care, ability to perform the usual activities, pain or discomfort, anxiety or depression) and a visual analog scale.
RESULTS
Data from 26 centers were collected (February 2017-March 2019). Complete data were available for 942/1005 consecutive patients (94.0%): 492 male (52.2%), median age 78 years (range = 70-95 years), and primary tumor was colorectal in 67.8%. A total 61.2% of all surgeries were via a minimally invasive approach. The 30-, 90-, and 180-day mortality was 3.7%, 6.3%, and 9%, respectively. At 30 and 180 days, postoperative morbidity was 39.2% and 52.4%, respectively, and Clavien-Dindo III-IV complications were 13.5% and 18.7%, respectively. The mean EQ-5D-3L index was similar before vs 3 months but improved at 6 months (0.79 vs 0.82; P < .001). Domains showing improvement were pain and anxiety or depression. A Flemish Triage Risk Screening Tool score greater than or equal to 2 (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.13 to 2.21, P = .007), palliative surgery (OR = 2.14, 95% CI = 1.01 to 4.52, P = .046), postoperative complications (OR = 1.95, 95% CI = 1.19 to 3.18, P = .007) correlated with worsening QoL.
CONCLUSIONS
GOSAFE shows that older adults' preoperative QoL is preserved 3 months after cancer surgery, independent of their age. Frailty screening tools, patient-reported outcomes, and goals-of-care discussions can guide decisions to pursue surgery and direct patients' expectations.
Identifiants
pubmed: 35394037
pii: 6565327
doi: 10.1093/jnci/djac071
pmc: PMC9275771
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
969-978Investigateurs
Giovanni Taffurelli
(G)
Davide Zattoni
(D)
Paola Tramelli
(P)
Giacomo Sermonesi
(G)
Giorgio Ercolani
(G)
Francesca Tauceri
(F)
Barbara Perenze
(B)
Daniela Di Pietrantonio
(DD)
Mariateresa Mirarchi
(M)
Gianluca Garulli
(G)
Vincenzo Alagna
(V)
Andrea Lucchi
(A)
Basilio Pirrera
(B)
Francesco Monari
(F)
Luigi Conti
(L)
Patrizio Capelli
(P)
Andrea Romboli
(A)
Gerardo Palmieri
(G)
Filippo Banchini
(F)
Francesca Di Candido
(FD)
Michele Carvello
(M)
Matteo Sacchi
(M)
Francesca De Lucia
(F)
Caterina Foppa
(C)
Luigi Marano
(L)
Alessandro Spaziani
(A)
Giampaolo Castagnoli
(G)
Alberto Bartoli
(A)
Laura Frain
(L)
Sam W Fox
(SW)
Kristin Cardin
(K)
Luis E De Leon
(LE)
Mario Trompetto
(M)
Gaetano Gallo
(G)
Alberto Realis Luc
(AR)
Giuseppe Clerico
(G)
Giuseppe Sammarco
(G)
Raffaele De Luca
(R)
Michele Simone
(M)
Rocco Lomonaco
(R)
Michael Fejka
(M)
Joshua I S Bleier
(JIS)
Matthijs Plas
(M)
Hanneke van der Wal-Huisman
(H)
Andrea Costanzi
(A)
Giulio Mari
(G)
Dario Maggioni
(D)
Roberta Pellegrino
(R)
Roberta Pellegrino
(R)
Pietro Ascheri
(P)
Jakub Kenig
(J)
Kinga Szabat
(K)
Stefano Scabini
(S)
Davide Pertile
(D)
Lorenzo Epis
(L)
Andrea Massobrio
(A)
Domenico Soriero
(D)
Arild Nesbakken
(A)
Ingeborg Flåten Backe
(IF)
Mariann Lønn
(M)
Giovanni Ferrari
(G)
Michele Mazzola
(M)
Carmelo Magistro
(C)
Pietro Achilli
(P)
Alessandro Giani
(A)
Orestis Ioannidis
(O)
Lydia Loutzidou
(L)
Konstantinos Galanos-Demiris
(K)
Genoveffa Balducci
(G)
Barbara Frezza
(B)
Alessio Lucarini
(A)
Claudia Santos
(C)
Diogo Cardoso
(D)
Isabela Gil
(I)
Vasco Cardoso
(V)
Lisa Cooper
(L)
Baha Siam
(B)
Yochai Levy
(Y)
Baruch Brenner
(B)
Hanoch Kashtan
(H)
Valerio Belgrano
(V)
Franco Decian
(F)
Beatrice Palermo
(B)
Roberto Eggenhöffner
(R)
Manuela Albertelli
(M)
Luis Sánchez-Guillén
(L)
Antonio Arroyo
(A)
Francisco López-Rodríguez
(F)
Sandra Lario
(S)
Cristina Lillo
(C)
Minas Baltatzis
(M)
Anthony K C Chan
(AKC)
Ajith K Siriwardena
(AK)
Giovanna Da Silva
(G)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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