M. C. Mason1,2, G. M. Barden1,2, N. Massarweh1,2,3, S. Sansgiry1, A. Walder1, D. L. White1, D. L. Castillo1, A. Naik1, D. H. Berger1,2,3, D. A. Anaya1,2,3 1Michael E. DeBakey Veterans Affairs Medical Center,Houston VA Center For Innovations In Quality, Effectiveness, And Safety (IQUEST),Houston, TX, USA 2Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 3Michael E. DeBakey Veterans Affairs Medical Center,Operative Care Line,Houston, TX, USA
Introduction: The Institute of Medicine recently emphasized the importance of patient-reported outcomes following cancer care, and their relevance for the growing geriatric population. There are limited data on the impact of cancer surgery on health-related quality of life (HRQoL) in elderly patients. The goal of our study was to examine trends over time and changes in HRQoL measures following cancer surgery, and to evaluate the effect of age and receipt of adjuvant therapy on these outcomes.
Methods: A prospective cohort study of patients undergoing elective cancer surgery at a tertiary referral center was performed (2012-2014). Demographic, clinical, cancer, and treatment variables were recorded. Cancer-specific HRQoL was prospectively measured using the EORTC C-30 questionnaire (6 domains) at the preoperative visit and at 1-month and 6-months postoperatively. The primary outcome of interest was a clinically significant drop in HRQoL, defined using the validated cutoff of a ≥10 point drop in Global Health Score (GHS) preoperatively to 6-month postoperatively. Patients were categorized based on their age into Young (<65y) and Elderly (≥65y), and trends over time as well as changes in GHS scores were compared between both groups. Univariate and multivariate logistic regression analyses were used to examine the association between age ≥ 65 and the primary outcome (Model 1) adjusting for receipt of adjuvant therapy (Model 2) and other important cofounders (Model 3).
Results: A total of 236 patients were included; 177 (75%) had major surgery, 105 (44.5%) were elderly, and 73 (31%) received adjuvant therapy. Baseline mean GHS score (67.2 [± 24.6]) dropped at 1-month (61.0 [± 25.0]) and increased close to baseline at 6-months (64.2 [± 23.4]) for the whole cohort, with no differences in trends over time between age groups. In all, 74 patients (31.4%) experienced a clinically significant drop in GHS score. Age ≥65 years was not associated with a clinically significant drop in HRQoL after univariate (Model 1: OR 1.62 [95% CI 0.93-2.82], P=0.09), and multivariate analyses (Model 2: OR 1.62 [0.93-2.83], P=0.09; and Model 3: OR 1.67 [0.93-2.99]; P=0.08).
Conclusions: Cancer patients overall experience a drop in HRQoL shortly after surgery (1-month), with a return close to baseline by 6 months. However, a high proportion of patients do not regain their baseline HRQoL, with almost one-third having a clinically significant drop that persists at 6 months postoperatively. Clinically significant drops in HRQoL were not associated with age ≥65 years, even among patients who received adjuvant therapy. Surgical and multimodality treatment should not be withheld from elderly patients based on concerns regarding long-term HRQoL.