Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: Influence on patient selection, prehabilitation and outcome

Ellen van der Vlies; Anke B Smits; Maartje Los; Marike van Hengel; Willem Jan W Bos; Lea M Dijksman; Eric P A van Dongen; Peter G Noordzij

doi:10.1016/j.jgo.2020.04.011

Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: Influence on patient selection, prehabilitation and outcome

J Geriatr Oncol. 2020 Nov;11(8):1237-1243. doi: 10.1016/j.jgo.2020.04.011. Epub 2020 Apr 29.

Authors

Ellen van der Vlies¹, Anke B Smits², Maartje Los³, Marike van Hengel⁴, Willem Jan W Bos¹, Lea M Dijksman⁵, Eric P A van Dongen⁶, Peter G Noordzij⁷

Affiliations

¹ Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Internal Medicine, Leiden University Medical Center, The Netherlands.
² Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
³ Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
⁴ Department of Geriatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.
⁵ Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands.
⁶ Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
⁷ Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: p.noordzij@antoniusziekenhuis.nl.

PMID: 32359885
DOI: 10.1016/j.jgo.2020.04.011

Abstract

Objective: To determine the influence of a preoperative multidisciplinary evaluation for frail older patients with colorectal cancer (CRC) on preoperative decision making and postoperative outcomes.

Background: Surgery is the main treatment for CRC. Older patients are at increased risk for adverse outcomes. For complex surgical cases, a multidisciplinary team (MDT) approach has been suggested to improve postoperative outcome. Evidence is lacking.

Methods: Historical cohort study from 2015 to 2018 in surgical patients ≥70 years with CRC. Frailty screening was used to appraise the somatic, functional and psychosocial health status. An MDT weighed the risk of surgery versus the expected gain in survival to guide preoperative decision making and initiate a prehabilitation program. Primary endpoint was the occurrence of a Clavien-Dindo (CD) Grade III-V complication. Secondary endpoints included the occurrence of any complication (CD II-V), length of hospital stay, discharge destination, readmission rate and overall survival.

Results: 466 patients were included and 146 (31.3%) patients were referred for MDT evaluation. MDT patients were more often too frail for surgery compared to non-MDT patients (10.3% vs 2.2%, P = .01). Frailty was associated with overall mortality (aOR 2.6 95% CI 1.1-6.1). Prehabilitation was more often performed in MDT patients (74.8% vs 23.4% in non-MDT patients). Despite an increased risk, MDT patients did not suffer more postoperative complications (CD III-V) than non-MDT patients (14.9% vs 12.4%; P = .48). Overall survival was worse in MDT patients (35 (32-37) vs 48 (47-50) months in non-MDT patients; P < .01).

Conclusions: Implementation of preoperative MDT evaluation for frail patients with CRC improves risk stratification and prehabilitation, resulting in comparable postoperative outcomes compared to non-frail patients. However, frail patients are at increased risk for worse overall survival.

Keywords: Colorectal cancer; Frailty; Multidisciplinary team approach; Prehabilitation; Preoperative decision making.

MeSH terms

Aged
Cohort Studies
Colorectal Neoplasms* / surgery
Frail Elderly*
Humans
Patient Care Team
Patient Selection
Postoperative Complications / epidemiology
Preoperative Exercise