Frailty and health related quality of life three months after non-metastatic colorectal cancer diagnosis in older patients: A multi-centre prospective observational study

The relationship between sleep quality and quality of life in middle-aged and older inpatients with chronic diseases: Mediating role of frailty and moderating role of self-esteem

OBJECTIVE

This study aimed to investigate the influence of sleep quality on the quality of life in middle-aged and older inpatients with chronic diseases (MAOICDs) while examining the mediating role of frailty and the moderating role of self-esteem.

METHODS

This study utilized a cross-sectional design. Between October 2021 and February 2022, we administered questionnaires to 319 subjects at the Second Hospital of Zhejiang University School of Medicine, Zhejiang Province, China. The questionnaire consisted of the General Information Scale, the Cumulative Disease Rating Scale, the Sleep Quality Questionnaire, the Frailty Scale, the Self-Esteem Scale, and the Quality of Life Questionnaire. Data were analyzed using SPSS 25.0 software and PROCESS3.5 macros for descriptive statistics, correlation analysis, and tests for mediating and moderating effects.

RESULTS

The results of this study suggest that sleep quality is negatively related to quality of life and mediated by frailty. Self-esteem plays a moderating role in the relationship between frailty and quality of life.

CONCLUSION

Frailty mediates the relationship between sleep quality and quality of life. Meanwhile, self-esteem plays a moderating role in the relationship between frailty and life quality. Specifically, the correlation between frailty and life quality becomes stronger at higher levels of self-esteem. Therefore, to improve the life quality of MAOICDs, interventions should focus not only on enhancing sleep quality and reducing frailty but also on helping patients maintain an appropriate level of self-esteem.

Assessment of cognitive function after surgery for colorectal cancer-a scoping review

OBJECTIVE

Colorectal cancer is primarily treated with surgery. Major surgery and older age are risk factors associated with postoperative decline in cognitive function. In clinical research, a wide range of instruments have been used to assess cognitive function. There are no clear criteria for the measurement of postoperative cognitive dysfunction. This scoping review aimed to map how and when cognitive function has been assessed after surgery for colorectal cancer and the reported incidence of postoperative cognitive decline.

DESIGN

Systematic scoping review following the JBI approach.

DATA SOURCES

Scopus and PubMed. Last search January 2023.

ELIGIBILITY CRITERIA

Reports with outcomes of postoperatively assessed cognitive function in colorectal cancer patients with first assessment within 1 year of surgery were included.

DATA EXTRACTION AND SYNTHESIS

Data were extracted by one researcher and controlled for accuracy by a second researcher. Data were summarised in tables and charts.

RESULTS

In total, 49 reports were included (16 clinical trials, 33 cohort studies). Cognitive function was assessed with patient-reported outcome measures, clinical screening tools, neurophysiological testing and complication classification. The definition was most often related to the specific instrument, as predefined cut-off or change from baseline. Assessments were performed between 1 hour and 36 months after surgery-few reports included follow-up both within and after 30 days postoperatively. Incidence of cognitive decline varied considerably (0%-64%), depending on the instrument, definition criteria and time of assessment. Most studies reported a decline in cognitive function after surgery with recovery during follow-up.

CONCLUSIONS

This study showed a heterogeneity in the choice of assessment method and measurement criteria for cognitive dysfunction after colorectal cancer surgery. A more unified measurement approach in further research would be beneficial to evaluate postoperative cognitive function and understand its impact on the daily lives of patients with colorectal cancer.

TRIAL REGISTRATION NUMBER

10.17605/OSF.IO/2M3DT.

Comparative study of the risk prediction model of early postoperative frailty in elderly enterostomy patients based on machine learning methods

Objective

Based on machine learning method, four types of early postoperative frailty risk prediction model of enterostomy patients were constructed to compare the performance of each model and provide the basis for preventing early postoperative frailty of elderly patients with enterostomy.

Methods

The prospective convenience sampling method was conducted and 362 early postoperative enterostomy patients were selected in three hospitals from July 2020 to November 2023 in Shanghai, four different prediction models of Support Vector Machine (SVM), Bayes, XG Boost, and Logistic regression were used and compared the test effects of the four models (MCC, F1, AUC, and Brier index) to judge the classification performance of the four models in the data of this study.

Results

A total of 21 variables were included in this study, and the predictors mainly covered demographic information, stoma-related information, quality of life, anxiety and depression, and frailty. The validated models on the test set are XGBoost, Logistic regression, SVM prediction model, and Bayes on the MCC and F1 scores; on the AUC, XGBoost, Logistic regression, Bayes, and SVM prediction model; on the Brier scores, Bayes, Logistic regression, and XGBoost.

Conclusion

XGBoost based on machine learning method is better than SVM prediction model, Logistic regression model and Bayes in sensitivity and accuracy. Quality of life in the early postoperative period can help guide clinical patients to identify patients at high risk of frailty and reduce the incidence of early postoperative frailty in elderly patients with enterostomy.

Geriatric Assessment in Colorectal Surgery: A Systematic Review

INTRODUCTION

The prevalence of colorectal surgery among older adults is expected to rise due to the aging population. Geriatric conditions (e.g., frailty) are risk factors for poor surgical outcomes. The goal of this systematic review is to examine how current literature describes geriatric assessment interventions in colorectal surgery and associated outcomes.

METHODS

Systematic searches of Ovid MEDLINE, Cochrane Library, CINAHL, Embase, and Web of Science were completed. Review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered in PROSPERO, the international prospective register of systematic reviews in health and social care. All cohort studies and randomized trials of adult colorectal surgery patients where geriatric assessment was performed were included. Geriatric assessment with/without management interventions were identified and described.

RESULTS

Seven-hundred ninety-three studies were identified. Duplicates (197) were removed. An additional 525 were excluded after title/abstract review. After full-text review, 20 studies met the criteria. Reference list review increased final total to 25 studies. All 25 studies were cohort studies. No randomized clinical trials were identified. Heterogeneous assessments were organized into geriatrics domains (mind, mobility, medications, matters most, and multi-complexity). Incomplete evaluations across geriatric domains were performed with few studies describing the use of assessments to impact management decisions.

CONCLUSIONS

There are no randomized trials assessing the impact of geriatric assessment to tailor management strategies and improve outcomes in colorectal surgery. Few studies performed assessments to evaluate the geriatric domain matters most. These findings represent a gap in evidence for the efficacy of geriatric assessment and management strategies in colorectal surgical care.

Health-Related Quality of Life after Hysterectomy for Endometrial Cancer: The Impact of Enhanced Recovery after Surgery Shifting Paradigm

OBJECTIVES

Enhanced recovery after surgery (ERAS) protocols provide well-known benefits in the immediate recovery with a shorter length of stay (LOS) and also in gynecological surgery. However, the impact of ERAS has not been clearly showed yet regarding long-term consequences and health-related quality of life (HRQL). The aim of this study was to investigate the impact of ERAS on HRQL after hysterectomy for endometrial cancer.

DESIGN

An observational retrospective study with propensity score matching (PSM) was performed.

PARTICIPANTS

We administered the SF-36 validated questionnaire to women underwent hysterectomy and lymph nodal staging before and after introducing ERAS protocol, getting, respectively, a standard practice (SP) and ERAS group.

SETTINGS

The study was conducted at the academic hospital.

METHODS

We collected demographic, clinical, surgical and postoperative data and performed a PSM of the baseline confounders. We administered the questionnaire 4 weeks after the surgery. The SF-36 measures HRQL using eight scales: physical functioning (PF), role physical (RLP), bodily pain (BP), general health (GH), vitality (Vt), social functioning (SF), role emotional (RLE) and mental health (MH).

RESULTS

After PSM, we enrolled a total of 154 patients, 77 in each group (SP and ERA). The two groups were similar in terms of age, BMI, anesthetic risk, Charlson comorbidity index (CCI), and surgical technique (minimally invasive vs. open access). Median LOS was shorter for ERAS group (5 vs. 3 days; p = 0.02), while no significant differences were registered in the rates of postoperative complications (16.9% vs. 17.4%; p = 0.66). Response rates to SF-36 questionnaire were 89% and 92%, respectively, in SP and ERAS group. At multivariate analyzes, the mean scores of SF-36 questionnaire, registered at 28 days weeks after surgery (range 26-32 days), were significantly higher in ERAS group for PF (73.3 vs. 91.6; p < 0.00), RLP (median 58.3 vs. 81.2; p = 0.02), and SF (37.5 vs. 58.3; p = 0.01) domains, when compared to SP patients.

LIMITATIONS

Further follow-up was not possible due to the anonymized data derived from clinical audit.

CONCLUSIONS

ERAS significantly increases the HRQL of women who underwent surgery for endometrial cancer. HRQL assessment should be routinely implemented in the ERAS protocol.

Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty

Frailty is characterized by reduced physiological reserves across multiple systems. In patients with frailty, oncological surgery has been associated with a high rate of postoperative complications and worse overall survival. Further, given that cancer and frailty can co-exist in the same patient, cancer and cancer-related symptoms can rapidly accelerate the progression of baseline frailty, which we have termed "cancer frailty". This distinction is clinically meaningful because the prioritization of interventions and the treatment outcomes may differ based on health conditions. Specifically, in patients with cancer frailty, improvements in frailty may be achieved via surgical removal of tumors, while prehabilitation may be less effective, which may in turn result in delayed treatment and cancer progression. In this review, we focused on challenges in the surgical treatment of non-metastatic colorectal cancers in patients with frailty, including those related to decision making, prehabilitation, and surgery. Potential recommendations for treating patients with cancer frailty are also discussed.

Health-related quality-of-life trajectories during/after surgery and adjuvant chemotherapy in patients with colon cancer

PURPOSE

This study aims to evaluate quality of life trajectory during the first year after surgical treatment in patients with resectable primary colon cancer.

METHODS

Patients with resectable primary colon cancer diagnosed between 2013 and 2019 who received surgical treatment and adjuvant chemotherapy if indicated were selected from the Prospective Dutch ColoRectal Cancer cohort study (PLCRC). Health-related quality of life (HR-QoL) was assessed using EORTC-QLQ-C30 questionnaire before surgery, and three and twelve months after surgery. HR-QoL scores varied between 0 and 100 and outcomes were compared according to age (< 70 years, ≥ 70 years), comorbidity (yes, no) and treatment type (adjuvant chemotherapy, surgical treatment only). The extent of resilience, defined as a recovery of HR-QoL to baseline level after a clinically relevant decline in HR-QoL at months, was calculated twelve months post-surgery.

RESULTS

For all 458 patients, the mean age was 66.4 years (SD 9.5), 40% were aged 70 years and older and 68% were men. Baseline level of HR-QoL summary score was relatively high with a mean of 87.9 (SD 11.5), and did not significantly differ between older and younger patients. The strongest decline of HR-QoL compared to baseline was observed at three months with a gradual recovery over time. Fourteen percent of all patients were non-resilient or showed a late decline at twelve months post-surgery. Compared to younger patients, older patients who received adjuvant chemotherapy were less resilient (respectively, 53 and 32%, p = 0.07) and at risk of a late decline in HR-QoL 1 year post-surgery (respectively, 3% versus 16%, p = 0.02). Comorbidity status had no significant impact on the HR-QoL trajectory.

CONCLUSION

Colon cancer treatment was associated with a decline in HR-QoL three months post-surgery, but most patients return to baseline level within twelve months. Still, particularly older patients who received adjuvant chemotherapy were less resilient and at risk of a late decline in HR-QoL. These data could help in patients counselling regarding colon cancer treatment.

Prospective Evaluation of the Quality of Life of Patients after Surgical Treatment of Rectal Cancer: A 12-Month Cohort Observation

This study constitutes a prospective, three-stage evaluation of quality of life among patients receiving surgical treatment for colorectal cancer depending on the type of surgery performed (open anterior resection, laparoscopic anterior resection, abdominoperineal resection, or Hartmann’s procedure). The study included 82 patients treated at the Surgical Oncology Outpatient Department of the Oncology Center in Bydgoszcz from June 2019 to August 2021. The study tools consisted of diagnostic surveys and analyses of medical records. The standardized study tools were the surveys EORTC QLQ-C30 and QLQ-CR29. In addition, a proprietary questionnaire was developed to collect demographic data. Quality of life was measured at three time-points: the day before the surgery and 6 and 12 months post-surgery. Statistically significant differences (p < 0.05) were observed in the domains of role functioning (III, p = 0.030), body image (II, p < 0.001; III, p < 0.001), sexual functioning (II, p = 0.037), buttocks/anal area/rectum pain (III, p = 0.031), and embarrassment (II, p = 0.022; III, p = 0.010). Statistically significant differences in the functional and symptom scale scores were also observed within each group at different stages of cancer treatment. As shown by our study, the quality of life of patients treated for colorectal cancer is determined not only by the operating technique but also by sociodemographic and clinical factors. The use of minimally invasive surgical techniques enables patients to return to their social roles more quickly and improves their self-assessment of body image.