Abstract
Optimal surgical management of older adults with cancer starts pre-operatively. The surgeon plays a key role in the appropriate selection of patients and procedures, optimisation of their functional status prior to surgery, and provision of more intensive care for those who are at high risk of post-operative complications. The literature, mainly based on retrospective, non-randomised studies, suggests that factors such as age, co-morbidities, pre-operative cognitive function and intensity of the surgical procedure all appear to contribute to the development of post-operative complications. Several studies have shown that a pre-operative geriatric assessment predicts post-operative mortality and morbidity as well as survival in older surgical cancer patients. Geriatricians are used to working in multidisciplinary teams that assess older patients and make individual treatment plans. However, the role of the geriatrician in the surgical oncology setting is not well established. A geriatrician could be a valuable contribution to the treatment team both in the pre-operative stage (patient assessment and pre-operative optimisation) and the post-operative stage (patient assessment and treatment of medical complications as well as discharge planning).
Highlights
Age is the single biggest risk factor for developing cancer and most cancer-related deaths occur in the older age group
These studies suggest that minimally invasive procedures have similar overall survival to that of open procedures and should be considered in the elderly patients with impaired functional status, with the aim to decrease the extent of surgical insult and post-operative complications, shorten length of stay and promote quicker recovery
They found that a number of factors measured pre-operatively increased the risk of post-operative complications: smoking, Charlson Comorbidity Index (CCI) score of 3 or more, duration of surgery greater than 180 min was associated with increased risk of post-operative complications
Summary
Age is the single biggest risk factor for developing cancer and most cancer-related deaths occur in the older age group. Alongside geriatric considerations as will be discussed below, it means that treatment offered may differ from that of their younger counterparts, with non-surgical options as potential alternatives (Table 1). Based on a geriatric assessment is it possible to identify older patients who are frail and at risk of surgical complications. If the older patient is frail and has a limited life expectancy combined with a high risk of surgical complications, the goals of treatment may deviate from what is expected in a younger or fitter patient. CGA can allow an individualised patient plan and treatment goal to be established. This opinion paper primarily focuses on the potential and emerging integrative roles of the surgeon and geriatrician in this environment
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