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Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study

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...

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Autores principales: Montroni, Isacco, Ugolini, Giampaolo, Saur, Nicole M, Rostoft, Siri, Spinelli, Antonino, Van Leeuwen, Barbara L, De Liguori Carino, Nicola, Ghignone, Federico, Jaklitsch, Michael T, Somasundar, Ponnandai, Garutti, Anna, Zingaretti, Chiara, Foca, Flavia, Vertogen, Bernadette, Nanni, Oriana, Wexner, Steven D, Audisio, Riccardo A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275771/
https://www.ncbi.nlm.nih.gov/pubmed/35394037
http://dx.doi.org/10.1093/jnci/djac071
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author Montroni, Isacco
Ugolini, Giampaolo
Saur, Nicole M
Rostoft, Siri
Spinelli, Antonino
Van Leeuwen, Barbara L
De Liguori Carino, Nicola
Ghignone, Federico
Jaklitsch, Michael T
Somasundar, Ponnandai
Garutti, Anna
Zingaretti, Chiara
Foca, Flavia
Vertogen, Bernadette
Nanni, Oriana
Wexner, Steven D
Audisio, Riccardo A
author_facet Montroni, Isacco
Ugolini, Giampaolo
Saur, Nicole M
Rostoft, Siri
Spinelli, Antonino
Van Leeuwen, Barbara L
De Liguori Carino, Nicola
Ghignone, Federico
Jaklitsch, Michael T
Somasundar, Ponnandai
Garutti, Anna
Zingaretti, Chiara
Foca, Flavia
Vertogen, Bernadette
Nanni, Oriana
Wexner, Steven D
Audisio, Riccardo A
author_sort Montroni, Isacco
collection PubMed
description 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.
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spelling pubmed-92757712022-09-08 Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study Montroni, Isacco Ugolini, Giampaolo Saur, Nicole M Rostoft, Siri Spinelli, Antonino Van Leeuwen, Barbara L De Liguori Carino, Nicola Ghignone, Federico Jaklitsch, Michael T Somasundar, Ponnandai Garutti, Anna Zingaretti, Chiara Foca, Flavia Vertogen, Bernadette Nanni, Oriana Wexner, Steven D Audisio, Riccardo A J Natl Cancer Inst Articles 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. Oxford University Press 2022-04-08 /pmc/articles/PMC9275771/ /pubmed/35394037 http://dx.doi.org/10.1093/jnci/djac071 Text en © The Author(s) 2022. Published by Oxford University Press. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Articles
Montroni, Isacco
Ugolini, Giampaolo
Saur, Nicole M
Rostoft, Siri
Spinelli, Antonino
Van Leeuwen, Barbara L
De Liguori Carino, Nicola
Ghignone, Federico
Jaklitsch, Michael T
Somasundar, Ponnandai
Garutti, Anna
Zingaretti, Chiara
Foca, Flavia
Vertogen, Bernadette
Nanni, Oriana
Wexner, Steven D
Audisio, Riccardo A
Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
title Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
title_full Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
title_fullStr Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
title_full_unstemmed Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
title_short Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
title_sort quality of life in older adults after major cancer surgery: the gosafe international study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275771/
https://www.ncbi.nlm.nih.gov/pubmed/35394037
http://dx.doi.org/10.1093/jnci/djac071
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