Self-reported electronic symptom monitoring in older patients with multimorbidity treated for cancer: Development of a core dataset based on expert consensus, literature review, and quality of life questionnaires

Preoperative management in octogenarian patients with rectal cancer

Background

In recent years, the rise in average lifespan has been linked to an increase in the occurrence of diseases associated with aging worldwide. Rectal tumors often occur in elderly patients.

Methods

Between January and August 2024, 6 experts in colorectal cancer met to develop an algorithm to organize the interdisciplinary and multimodal preoperative approaches in the octogenarian population with rectal cancer. To develop the algorithm, we conducted a straightforward search within the PubMed database and also reviewed the citations of the most pertinent articles we discovered. The quality of the methods used in the final selection of 76 sources was evaluated, every single source was scrutinized and analyzed, and a team of six experts created an algorithm.

Results

An algorithm for preoperative management of octogenarian patients with rectal cancer was created to encapsulate essential information and provide a contemporary resource for physicians, surgeons, physiotherapists, and nutritionists to utilize in optimal clinical practice.

Conclusions

Octogenarian patients with rectal cancer are special-character groups and require specific preoperative management to better the surgical outcome.

Study protocol for two stepped-wedge interventional trials evaluating the effects of holistic information technology-based patient-oriented management in older multimorbid patients with cancer: The GERONTE trials

INTRODUCTION

Current hospital-based care pathways are generally single-disease centred. As a result, coexisting morbidities are often suboptimally evaluated and managed, a deficiency becoming increasingly apparent among older patients who exhibit heterogeneity in health status, functional abilities, frailty, and other geriatric impairments. To address this issue, our study aims to assess a newly developed patient-centred care pathway for older patients with multimorbidity and cancer. The new care pathway was based on currently available evidence and co-designed by end-users including health care professionals, patients, and informal caregivers. Within this care pathway, all healthcare professionals involved in the care of older patients with multimorbidity and cancer will form a Health Professional Consortium (HPC). The role of the HPC will be to centralise oncologic and non-oncologic treatment recommendations in accordance with the patient's priorities. Moreover, an Advanced Practice Nurse will act as case-manager by being the primary point of contact for the patient, thus improving coordination between specialists, and by organising and leading the consortium. Patient monitoring and the HPC collaboration will be facilitated by digital communication tools designed specifically for this purpose, with the added benefit of being customisable for each patient.

MATERIALS AND METHODS

The GERONTE study is a prospective international, multicentric study consisting of two stepped-wedge trials performed at 16 clinical sites across three European countries. Each trial will include 720 patients aged 70 years and over with a new or progressive cancer (breast, lung, colorectal, prostate) and at least one moderate or severe multimorbidity. The patients in the intervention group will receive the new care pathway whereas patients in the control group will receive usual oncologic care.

DISCUSSION

GERONTE will evaluate whether this kind of holistic, patient-oriented healthcare management can improve quality of life (primary outcome) and other valuable endpoints in older patients with multimorbidity and cancer. An ancillary study will assess in depth the socio-economic impact of the intervention and deliver concrete implementation guidelines for the GERONTE intervention care pathway.

TRIAL REGISTRATION

FRONE: NCT05720910 TWOBE: NCT05423808.