1. The effect of treatment modifications by an onco-geriatric MDT on one-year mortality, days spent at home and postoperative complications
- Author
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Geertruida H. de Bock, Suzanne Festen, Annya H D van der Leest, Barbara L. van Leeuwen, Pauline de Graeff, Anna K.L. Reyners, Hanneke van der Wal-Huisman, Targeted Gynaecologic Oncology (TARGON), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Life Course Epidemiology (LCE), and Damage and Repair in Cancer Development and Cancer Treatment (DARE)
- Subjects
PREDICTOR ,medicine.medical_specialty ,SURGERY ,Colorectal cancer ,DECISION-MAKING ,Malignancy ,COLORECTAL-CANCER ,One year mortality ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,OUTCOME PRIORITIZATION ,Older patients ,Internal medicine ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,ELDERLY-PATIENTS ,FRAILTY ,Geriatric Assessment ,Aged ,Retrospective Studies ,Days spent at home ,OLDER PATIENTS ,business.industry ,Patient preferences ,Retrospective cohort study ,Geriatric assessment ,ASSOCIATION ,Treatment decision-making ,University hospital ,medicine.disease ,Oncology ,030220 oncology & carcinogenesis ,SURVIVAL ,Female ,Treatment decision making ,Geriatrics and Gerontology ,business ,Older cancer patients - Abstract
Objectives: Decision-making in older patients with cancer can be complex, as benefits of treatment should be weighed against possible side-effects and life-expectancy. A novel care pathway was set up incorporating geriatric assessment into treatment decision-making for older cancer patients. Treatment decisions could be modified following discussion in an onco-geriatric multidisciplinary team (MDT). We assessed the effect of treatment modifications on outcomes. Materials and methods: This retrospective study was performed in the surgical department of a University Hospital. Patients of 70 years and older with a solid malignancy were included. All patients underwent a nurse-led geriatric assessment (GA) and were discussed in an onco-geriatric MDT. This could result in a modified or an unchanged treatment advice compared to the regular tumor board. Primary outcome was one-year mortality. Secondary outcomes were post-operative complications and days spent in hospital in the first year after inclusion. Results: For the 184 patients in the analyses, the median age was 77.5 years and 41.8% were female. For 46 patients (25%), the treatment advice was modified by the onco-geriatric MDT. There was no significant difference in one-year mortality between the unchanged and modified group (29.7% versus 26.1%, p = 0.7). There were, however, significantly fewer days spent in hospital (median 5 vs 8.5 days p = 0.02) and fewer grade II or higher postoperative complications (13.3% versus 35.5% p = 0.005) in the modified group. Conclusion: Incorporating geriatric assessment in decision-making did not lead to excess one-year mortality, but did result in fewer complications and days spent in hospital. (c) 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
- Published
- 2020