In older patients with cancer undergoing surgical treatment, collaboration between surgical and geriatric teams significantly decreases 90-day postoperative mortality.
Patients aged 75 years and older face unique challenges when undergoing cancer-related surgery, including an increased risk of adverse postoperative events, a heightened risk of delirium, difficulties in recovering mobility and functional activity, and the need for appropriate care after hospital discharge. However, collaboration between surgeons and geriatricians is sporadic, and little data exists regarding the benefits of geriatric comanagement of care for patients with cancer in the surgical setting.
In a study published today in JAMA Network Open, a team of researchers led by Armin Shahrokni, MD, MPH, an oncologist in the Geriatrics Service at Memorial Sloan Kettering Cancer Center, investigated the association between geriatric comanagement of care and postoperative outcomes in older patients undergoing surgical treatment. The study included 1,892 patients who received cancer-related surgical procedures between February 2015 and February 2018. Eligible patients were at least 75 years of age and had a hospital stay of at least one day. The primary end point was 90-day postoperative mortality, with secondary end points of adverse surgical events, rate of emergency department visits or hospital readmission, and utilization of inpatient supportive care services.
Geriatric comanagement of care was received by 53.9% of patients included in the study. The adjusted probability of mortality within 90 days of surgery was significantly lower in patients who received geriatric care compared to those who received surgical service care only (4.3% vs 8.9%). Adverse events occurred in 20.6% of patients in the geriatric care group and in 21.8% in the surgical service group, a difference which did not reach statistical significance. A higher proportion of patients in the geriatric care group utilized supportive care services in the inpatient setting, including physical therapy (80.4% vs 63.6%), occupational therapy (37.7% vs 25.2%), speech and swallow rehabilitation (8.4% vs 4.8%), and nutrition services (78.7% vs 73.1%). Additionally, more patients receiving geriatric comanagement of care were discharged with home supportive services (18.0% vs 13.6%).
"This cohort study found that older patients whose care was comanaged by the geriatrics and surgical services had significantly lower 90-day postoperative mortality than patients whose care was managed by the surgical service only," conclude Dr. Shahrokni and colleagues. "These findings suggest that when feasible, older patients undergoing surgical treatment for cancer should receive geriatric care comanagement as part of their perioperative care."
For More Information
Shahrokni A, Tin AL, Sarraf S, et al (2020). Association of geriatric comanagement and 90-day postoperative mortality among patients aged 75 years and older with cancer. JAMA Netw Open. [Epub ahead of print] DOI:10.1001/jamanetworkopen.2020.9265
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