Perioperative medicine for Older People undergoing Surgery office, C/O Older Person's Assessment Unit, Ground Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
Intensive Care Unit, Royal Surrey County Hospital, Egerton Rd, Guildford GU2 7XX, UK.
J Geriatr Oncol. 2024 Mar;15(2):101678. doi: 10.1016/j.jgo.2023.101678. Epub 2023 Dec 19.
Population aging longevity and advances in robotic surgery suggest that increasing numbers of older women having gynaeoncological surgery is likely. Postoperative morbidity and mortality are more common in older than younger women with the age-associated characteristics of multimorbidity and frailty being generally predictive of worse outcome. Priorities that inform treatment decisions change during the life course: older patients often place greater' value on quality-of-life-years gained than on life expectancy following cancer treatments. However, data on post-operative cognition, frailty, or functional independence is sparse and not routinely collected. This study aimed to describe the clinical characteristics and trajectory of functional change of older women in the 12 months following gynaeoncological surgery and to explore the associations between them.
The prospective observational cohort study recruited consecutive women aged 65 or over scheduled for major gynaeoncologic surgery between July 2017 and April 2019. Baseline data on cancer stage, multimorbidity, and geriatric syndromes including cognition, frailty, and functional abilities were collected using standardised tools. Delirium and post-operative morbidity were recorded. Post hospital assessments were collected at 3-, 6-, and 12-months.
Overall, of 103 eligible participants assessed pre-operatively, most (77, 70%) remained independent in personal care at all assessments from discharge to 12 months. Functional trajectories varied widely over the 12 months but overall there was no significant decline or improvement for the 85 survivors. Eleven experienced a clinically significant decline in function at six months. This was associated with baseline low mood (P < 0.05), albeit with small numbers (6 of 11). Cognitive impairment and frailty were associated with lower baseline function but not with subsequent functional decline.
There was no clear clinical profile to identify the minority of older adults who experienced a clinically significant decline six months after surgery and for most, the decline was transient. This may be helpful in enabling informed patient consent. Assessment for geriatric syndromes and frailty may improve individual care but our findings do not indicate criteria for segmenting the patient population for selective attention. Future work should focus on causal pathways to potentially avoidable decline in those patients where this is not determined by the cancer itself.
人口老龄化、寿命延长和机器人手术的进步表明，接受妇科肿瘤手术的老年女性人数可能会增加。与年轻女性相比，老年女性术后发病率和死亡率更高，多种疾病并存和虚弱等与年龄相关的特征通常预示着预后更差。治疗决策的优先事项会随着生命历程而变化：老年患者通常更看重癌症治疗后获得的生活质量年数，而不是预期寿命。然而，关于术后认知、虚弱或功能独立性的数据很少，且未常规收集。本研究旨在描述妇科肿瘤手术后 12 个月内老年女性的临床特征和功能变化轨迹，并探讨它们之间的关系。
这项前瞻性观察性队列研究招募了 2017 年 7 月至 2019 年 4 月期间计划接受妇科重大肿瘤手术的 65 岁及以上的连续女性患者。使用标准化工具收集癌症分期、多种疾病和包括认知、虚弱和功能能力在内的老年综合征的基线数据。记录谵妄和术后发病率。出院后 3、6 和 12 个月进行医院评估。
总体而言，在 103 名术前评估合格的参与者中，大多数（77%，70%）在所有评估中（从出院到 12 个月）仍能独立自理。12 个月的功能轨迹差异很大，但对于 85 名幸存者来说，整体没有明显的下降或改善。11 人在 6 个月时功能出现显著下降。这与基线时情绪低落有关（P<0.05），尽管人数较少（11 人中有 6 人）。认知障碍和虚弱与较低的基线功能有关，但与随后的功能下降无关。
没有明确的临床特征可以识别术后 6 个月经历临床显著下降的少数老年患者，而且大多数患者的下降是短暂的。这可能有助于获得知情同意。对老年综合征和虚弱的评估可能会改善个体护理，但我们的研究结果并未表明为选择性关注患者人群划定标准的依据。未来的工作应重点关注潜在可避免的下降的因果途径，而不是由癌症本身决定。
