Surgery Often Yields ‘Restoration’ of Good QOL in Colorectal Cancers

"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 [QOL at] 3 and 6 months after surgery in the majority of cases," according to the study authors.

Many older patients with colon or rectal cancer experienced positive quality-of-life (QOL) and functional recovery outcomes following major elective colorectal surgery; moreover, patient frailty correlated with poorer outcomes, according to findings from the prospective GOSAFE study published in the Journal of Clinical Oncology.

At 3 to 6 months following surgery, 68.9% to 70.3% patients overall experienced equal or better QOL, including 72.8% to 72.9% of those with colon cancer and 60.1% to 63.9% of those with rectal cancer. Preoperative scores of 2 or greater according to the Flemish Triage Risk Screening Tool were associated with reduced QOL following surgery at both the 3-month (odds ratio [OR], 1.68; 95% CI, 1.04-2.73; P = .034) and 6-month (OR, 1.71; 95% CI, 1.06-2.75; P = .027) time points.

The same was true of postoperative complications at both the 3-month (OR, 2.03; 95% CI, 1.20-3.42; P = .008) and 6-month (OR, 2.56; 95% CI, 1.15-5.68; P = .02) time points. An ECOG performance status of 2 or greater was another predictor of post-surgical QOL decline among patients with rectal cancer (OR, 3.81; 95% CI, 1.45-9.92; P = .006).

In total, 78.6% (n = 254) of those with colon cancer and 70.6% (n = 94) of those with rectal cancer experienced functional recovery. The major risk factors for experiencing no functional recovery were a Charlson Age Comorbidity Index of 7 or greater (OR, 2.59; 95% CI, 1.26-5.32; P = .009), an ECOG performance status of 2 or greater among recipients of both colon (OR, 3.12; 95% CI, 1.36-7.20; P = .007) and rectal (OR, 4.61; 95% CI, 1.45-14.63; P = .009) surgery, and severe complications (OR, 17.33; 95% CI, 7.30-40.8; P <.001). Other major risk factors included preoperative scores of 2 or greater according to the Flemish Triage Risk Screening Tool (OR, 2.71; 95% CI, 1.40-5.25; P = .003) and receipt of palliative surgery (OR, 4.11; 95% CI, 1.29-13.07; P = .017).

“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 [QOL at] 3 and 6 months after surgery in the majority of cases,” the investigators wrote. “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.”

Investigators drew these findings from an analysis of 646 patients across 26 centers in the GOSAFE study group between February 2017 and April 2019. Complete datasets were obtained for 625 patients in this population, consisting of 435 patients with colon cancer and 190 with rectal cancer. The population’s median age was 79.0 years (interquartile range, 74.6-82.9), and most patients were male (52.6%).

Overall, 9.8% of patients had moderate to severe malnutrition and 23.3% had cognitive impairment. A minimally invasive surgical approach was employed for 73.0% of patients, including in 73.8% of colonic surgeries and 71.1% of rectal surgeries. In the rectal cancer cohort, 35.3% underwent a proctectomy with a permanent colostomy, 34.2% underwent a proctectomy with primary anastomosis, and 30.5% underwent a restorative proctectomy with a temporary ileostomy, which investigators reversed in the ensuing months in 67.2% of those this group.

Investigators noted several limitations to the study, including the small proportion of patients lost to follow-up and the failure to collect data on prospectively-enrolled patients who were ineligible for surgery.

“Frailty screening tools, history of delirium, and postoperative complications correlate with a worse QOL and [rate of functional recovery],” the investigators concluded. “These items and their correlation with the restoration of QOL and function should guide the conversation about possible surgical strategies.”

Reference

Montroni I, Ugolini G, Saur NM, et al. Predicting functional recovery and quality of life in older patients undergoing colorectal cancer surgery: real-world data from the international GOSAFE study. J Clin Oncol. Published online June 30, 2023. doi:10.1200/JCO.22.02195