Geriatric Comanagement Tied to Lower Mortality After Cancer Surgery

Medscape
23 Sep, 2020 ,

A recent study suggests that patients aged 75 and older who undergo cancer surgery have lower 90-day postoperative mortality when they receive geriatric co-management than when they don't. Researchers examined data on 1,892 patients 75 and older who had elective surgery with at least a one-day hospital stay at Memorial Sloan Kettering Cancer Center in New York City, including 1,020 patients who received geriatric co-management.

Source
Full content

Patients aged 75 and older who undergo cancer surgery have lower 90-day postoperative mortality when they receive geriatric co-management than when they don't, a recent study suggests.

Researchers examined data on 1,892 patients 75 and older who had elective surgery with at least a one-day hospital stay at Memorial Sloan Kettering Cancer Center in New York City, including 1,020 patients who received geriatric co-management.

A total of 36 patients who received geriatric co-management and 92 patients who didn't died within 90 days of surgery. The adjusted probability of death within 90 days was 4.3% with geriatric co-management and 8.9% without it, researchers report in JAMA Network Open.

"Older adults with cancer are at higher risk than younger patients for surgical complications and mortality; therefore, there is a need to improve surgical outcomes of these older adults with cancer," said lead study author Dr. Armin Shahrokni, an assistant attending in geriatrics and gastrointestinal oncology services at Memorial Sloan Kettering Cancer Center.

"Our study showed that one way that we can potentially improve the outcomes of these patients is through collaboration between oncologic surgeons and geriatricians," Dr. Shahrokni said by email.

Patients in the study who received geriatric co-management were slightly older than those who didn't (mean age 81 v 80) and also had longer operative times (mean 203 minutes v 138 minutes) and longer length of stay (median 5 days v 4 days).

A total of 401 patients experienced adverse surgical outcomes, however this didn't differ between the two treatment groups in the study. The adjusted probability of adverse surgical outcomes was 20.6% with geriatric co-management and 21.8% without it.

More patients who received geriatric co-management (18%) were discharged home with services like visiting nurses than in the group that didn't receive geriatric co-management (13.6%).

Rates of support services like physical therapy, occupational therapy, speech and nutrition were similar for both groups in the study.

Limitations of the study include a lack of data on cancer stage or any preoperative systemic radiation or treatments that patients received, the study team notes. Researchers also didn't have data on some key outcomes like functional recovery and the ability to receive additional cancer treatment.

It's also possible that results from this single-center study might not be generalizable to outcomes elsewhere, said Dr. Nicole Saur, co-author of a commentary accompanying the study and an assistant professor of surgery at the University of Pennsylvania in Philadelphia.

Even so, the results suggest that geriatricians should be an integral part of the treatment team for geriatric surgery patients.

"They should see vulnerable geriatric patients at all phases of their surgical care and work with the surgical team to optimize patients for and help them recover from surgery," Dr. Saur said by email. "Optimal care for geriatric surgery patients includes multidisciplinary, multi-phase interventions to improve outcomes."