Older patients who undergo surgery to treat cancer are more likely to experience injuries and other health issues such as falling down, breaking bones, dehydration, bed sores, failure to thrive, and delirium. The risks are particularly notable in patients who undergo major abdominal surgery. These geriatric events are linked to operative mortality, prolonged hospitalization, and more expensive health care, according to a study published in the Journal of Clinical Oncology.1
“The findings highlight the importance for older patients to discuss these potential events with their doctors as they prepare for surgery,” said Hung-Jui Tan, MD, a fellow in urologic oncology at the University of California Los Angeles, and first author of the study. “Now that the prevalence of such events is known, treatment approaches that keep these age-related health concerns in mind may be better applied in the future to better assist these patients.”
The findings come from an 18-month study of Nationwide Inpatient Sample data from 2009 to 2011 that included 939 150 patients who were admitted to hospital for major cancer surgery. The patients examined included elderly patients, defined as those age 65 years or older, and a reference group who were age 55 to 64 years.
Geriatric events were defined to include delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. At least 1 event occurred in 9.2% of the patients. Geriatric events were more common in patients 75 years and older, with a Charlson comorbidity score of 2 or higher, and undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach.
This study sheds light on issues related to frailty and reduced functionality. These geriatric-specific conditions tend to be overshadowed by emphasis on survival rates and chemotherapy toxicity in many studies. The researchers hope these findings lead to better care planning and better outcomes for patients whose age puts them at higher risk.
These adverse events affect approximately 1 in 10 patients older than 54 years undergoing cancer surgery in the United States. “With even higher rates observed among the very old, patients 75 [years] and older, the fastest-growing segment of the population, geriatric events during cancer-related surgery are likely to become even more prevalent,” Tan said.
The study was funded by the Veterans Affairs Office of Academic Affiliations through the Robert Wood Johnson Foundation Clinical Scholars Program, the American Cancer Society Postdoctoral Fellowship Program, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Aging.
1. Tan HJ, Saliba D, Kwan L, et al. The burden of geriatric events among older adults undergoing major cancer surgery [published online ahead of print February 16, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.63.4592.