Abstract
BackgroundFrailty refers to the reduction in homeostatic reserve resulting from an accumulation of physiological deficits over a lifetime. Frailty is common in older patients undergoing surgery and is an independent risk factor for post-operative mortality, morbidity and increased length of hospital stay. In frail individuals, stressors, such as surgery, can precipitate an acute deterioration in health, manifesting as delirium, falls, reduction in mobility or continence, rendering these individuals at an increased risk of adverse perioperative outcomes. However, little is known about how frailty affects the patient experience, functional ability and quality of life (QoL) after surgery. In addition, the distribution of frailty in this population is unknown.MethodsWe will conduct a multi-centre observational trial to investigate the relationship between patient reported outcome measures and preoperative frailty. We aim to recruit approximately two-hundred patients with operable, potentially curative colorectal cancer. Eligible patients will be identified at three hospital sites. QoL and functional ability (measured using EORTC QLQ-C30 and WHO-DAS 2.0 respectively) will be recorded at the pre-operative assessment clinic, and at 6 and 12 weeks postoperatively. Frailty scores including the Edmonton Frail Scale (EFS) and Rockwood clinical frailty scale (CFS) will be calculated both preoperatively, and at 12 weeks post-operatively. Secondary outcome measures including post-operative morbidity and mortality will be measured using Clavien Dindo classification and 90-day mortality.DiscussionThis observational feasibility study seeks to define the prevalence of frailty in older (> 65 years) colorectal cancer patients and understand how frailty impacts on patient reported outcome measures. This information will help to inform larger studies relating to treatment decision algorithms and promote shared decision making in this population.
Highlights
Frailty refers to the reduction in homeostatic reserve resulting from an accumulation of physiological deficits over a lifetime
We seek to investigate the impact of frailty on Patient reported outcome measures (PROMS) in a group of patients with operable, non-palliative colorectal cancer
We aim to test the hypothesis that preoperative frailty in older patients undergoing surgery for operable nonpalliative colorectal cancer is positively associated with post-operative functional ability and inversely associated with postoperative quality of life (QoL)
Summary
Frailty refers to the reduction in homeostatic reserve resulting from an accumulation of physiological deficits over a lifetime. Little is known about how frailty affects the patient experience, functional ability and quality of life (QoL) after surgery. Frailty is a reduction in homeostatic reserve as a result of accumulated deficits through life, rendering affected individuals at increased risk of acute health deteriorations with stressor events e.g. surgery [1,2,3]. A consequence of this has been an increase in the number of people over the age of 75 years undergoing surgery; in England 1.5 million patients underwent surgery in 2006–7 [4] which increased to 2.5 million in 2014–2015 [5] Of this latter group, 30% were > 85 years, and the prevalence of frailty in this age group is estimated to be 25–50% [2]. We seek to investigate the impact of frailty on PROMS in a group of patients with operable, non-palliative colorectal cancer
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