In a study of real-world prospective data—GOSAFE—reported in the Journal of Clinical Oncology, Montroni et al found that the majority of patients aged ≥ 70 years undergoing colorectal cancer surgery showed maintained or improved quality of life and achieved functional recovery during follow-up.
Study Details
The international study included consecutively enrolled patients aged ≥ 70 years at 26 hospitals worldwide. Quality of life was assessed with the EQ-5D-3L. Functional recovery was defined as the combination of an Activity of Daily Living score of ≥ 5, a Timed Up & Go test time of < 20 seconds, and a MiniCog score of > 2.
Key Findings
The study involved prospective data, collected between February 2017 and April 2019, for 625 (96.9%) of 646 consecutive patients. Among the 625 patients, 435 had colon cancer and 190 had rectal cancer. Median age was 79.0 years. Surgery was minimally invasive in 73% of all patients, including 74% of those with colon cancer and 71% of those with rectal cancer; palliative surgery was performed in only 5.5% of patients.
Equal or better quality of life was reported in 69.0% of patients (including 72.8% of those with colon cancer and 60.2% of those with rectal cancer) at 3 months after surgery, and in 70.3% of patients (including 72.9% of those with colon cancer and 63.9% with rectal cancer) at 6 months after surgery.
On multivariate analysis, a preoperative Flemish Triage Risk Screening Tool (fTRST) score of ≥ 2 was associated with poorer quality of life at 3 months (odds ratio [OR] = 1.68, P = .034) and 6 months (OR = 1.71, P = .027). Postoperative complications were associated with poorer quality of life at 3 months (OR = 2.03, P = .008) and 6 months (OR = 2.56, P = .02). Eastern Cooperative Oncology Group (ECOG) performance status of ≥ 2 was associated with poorer quality of life in the rectal cancer subgroup (OR = 3.81, P = .006).
Functional recovery was reported for 254 (78.6%) of 323 evaluable patients with colon cancer and 94 (70.6%) of 133 with rectal cancer. Factors associated with not achieving functional recovery included: age-adjusted Charlson Comorbidity Index of ≥ 7 (OR = 2.59, P = .009); ECOG performance score of ≥ 2 (OR = 3.12, P = .007, for colon cancer group; OR = 4.61, P = .009 for rectal cancer group); severe postoperative complications (OR = 17.33, P < .001); fTRST score of ≥ 2 (OR = 2.71, P = .003); and palliative surgery (OR = 4.11, P = .017).
The investigators concluded, “The majority of older patients experience good quality of life and [experience functional recovery] after colorectal cancer surgery. Predictors for failing to achieve these essential outcomes are now defined to guide patients’ and families’ preoperative counseling.”
They noted, “To our knowledge, the GOSAFE real-world prospective data show, for the first time, that major colon and rectal surgery in older patients with cancer results in restoration of a good quality of life 3 and 6 months after surgery in the majority of cases. This demonstrates, together with the patients’ ability to maintain their function in most cases … that older patients can undergo potentially curative … major cancer surgery without compromising an important priority: remaining independent.”
Flavia Foca, BStat, of IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,” Meldola, Italy, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
