Comorbidity in older surgical cancer patients: influence on patient care and outcome

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Comorbidity in older surgical cancer patients
influence on patient care and outcome

• Maryska Janssen-Heijnen
• Saskia Houterman
• Valery Lemmens
• Medical specialists
• Jan Willem Coebergh
• Registrars

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Background and relevance

• Growing proportion of elderly patients
• more patients with comorbidity
• comorbidity may complicate surgery
• influence of comorbidity on outcome of surgery?
• Clinical relevance
• refining selection criteria for surgery
• ? anticipation and prevention of complications

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Eindhoven Cancer Registry

• Records comorbidity since 1993
• From medical records
• Adapted list of Charlson (J Chron Dis 1987)
• Patients with resectable cancer diagnosed between
  1995 and 2002 (only general hospitals) included
• Colon stage I-III (N5490)
• NSCLC stage I-II (N2002)
• Additional information on postoperative
  complications for a random sample of 270 colon
  cancer patients and 164 NSCLC patients

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Results

• Comorbidity
• Influence on resection rate?
• Influence on postoperative complications?
• Influence on prognosis?

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Plt0.01
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Results

• Comorbidity
• Influence on resection rate?
• Influence on postoperative complications?
• Influence on prognosis?

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P?0.05
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P?0.05
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Prognosticators for complications
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Results

• Comorbidity
• Influence on resection rate?
• Influence on postoperative complications?
• Influence on prognosis?

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Multivariable analyses Independent prognostic
effect cardiovascular diseases, COPD, diabetes,
and 2 comorbid conditions
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Multivariable analyses Only independent
prognostic effect 2 comorbid conditions
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Summary

• No influence comorbidity on resection rate colon
  cancer (surgery inevitable)
• Less surgery for loc NSCLC with COPD (alternative
  available)
• 3-5-fold more postoperative death among elderly
  (especially with cardiovascular diseases or COPD)
• Comorbidity ? poorer prognosis colon cancer (esp.
  cardiovascular, COPD, diabetes)

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Conclusions

• Prospective randomized studies are needed for
  refining selection criteria for surgery in
  elderly cancer patients, e.g.
• Which comorbid conditions are a contra-indication
  for surgery? (prevention of complications)
• When should a surgeon be alert to anticipate
  postoperative complications?