Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study
Authors: Montroni Isacco , Ugolini Giampaolo , Saur Nicole M , Rostoft Siri , Spinelli Antonino , Van Leeuwen Barbara L , De Liguori Carino Nicola , Ghignone Federico , Jaklitsch Michael T , Somasundar Ponnandai , Garutti Anna , Zingaretti Chiara , Foca Flavia , Vertogen Bernadette , Nanni Oriana , Wexner Steven D , Audisio Riccardo A ,   the SIOG Surgical Task Force/ESSO GOSAFE Study Group, Taffurelli Giovanni , Zattoni Davide , Tramelli Paola , Sermonesi Giacomo , Ercolani Giorgio , Tauceri Francesca , Perenze Barbara , Pietrantonio Daniela Di , Mirarchi Mariateresa , Garulli Gianluca , Alagna Vincenzo , Lucchi Andrea , Pirrera Basilio , Monari Francesco , Conti Luigi , Capelli Patrizio , Romboli Andrea , Palmieri Gerardo , Banchini Filippo , Candido Francesca Di , Carvello Michele , Sacchi Matteo , Lucia Francesca De , Foppa Caterina , Marano Luigi , Spaziani Alessandro , Castagnoli Giampaolo , Bartoli Alberto , Frain Laura , Fox Sam W , Cardin Kristin , Leon Luis E De , Trompetto Mario , Gallo Gaetano , Luc Alberto Realis , Clerico Giuseppe , Sammarco Giuseppe , Luca Raffaele De , Simone Michele , Lomonaco Rocco , Fejka Michael , Bleier Joshua I S , Plas Matthijs , van der Wal-Huisman Hanneke , Costanzi Andrea , Mari Giulio , Maggioni Dario , Pellegrino Roberta , Pellegrino Roberta , Ascheri Pietro , Kenig Jakub , Szabat Kinga , Scabini Stefano , Pertile Davide , Epis Lorenzo , Massobrio Andrea , Soriero Domenico , Nesbakken Arild , Backe Ingeborg Flåten , Lønn Mariann , Ferrari Giovanni , Mazzola Michele , Magistro Carmelo , Achilli Pietro , Giani Alessandro , Ioannidis Orestis , Loutzidou Lydia , Galanos-Demiris Konstantinos , Balducci Genoveffa , Frezza Barbara , Lucarini Alessio , Santos Claudia , Cardoso Diogo , Gil Isabela , Cardoso Vasco , Cooper Lisa , Siam Baha , Levy Yochai , Brenner Baruch , Kashtan Hanoch , Belgrano Valerio , Decian Franco , Palermo Beatrice , Eggenhöffner Roberto , Albertelli Manuela , Sánchez-Guillén Luis , Arroyo Antonio , López-Rodríguez Francisco , Lario Sandra , Lillo Cristina , Baltatzis Minas , Chan Anthony K C , Siriwardena Ajith K , Da Silva Giovanna 
Published: April 2022

Abstract

Background
Accurate quality of life (QoL) data and functional results after cancer surgery are lacking for older patients. The international, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) Study compares QoL before and after surgery and identifies predictors of decline in QoL.

Methods
GOSAFE prospectively collected data before and after major elective cancer surgery on older adults (≥70 years). Frailty assessment was performed and postoperative outcomes recorded (30, 90, and 180 days postoperatively) together with QoL data by means of the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L), including 2 components: an index (range = 0-1) generated by 5 domains (mobility, self-care, ability to perform the usual activities, pain or discomfort, anxiety or depression) and a visual analog scale.

Results
Data from 26 centers were collected (February 2017-March 2019). Complete data were available for 942/1005 consecutive patients (94.0%): 492 male (52.2%), median age 78 years (range = 70-95 years), and primary tumor was colorectal in 67.8%. A total 61.2% of all surgeries were via a minimally invasive approach. The 30-, 90-, and 180-day mortality was 3.7%, 6.3%, and 9%, respectively. At 30 and 180 days, postoperative morbidity was 39.2% and 52.4%, respectively, and Clavien-Dindo III-IV complications were 13.5% and 18.7%, respectively. The mean EQ-5D-3L index was similar before vs 3 months but improved at 6 months (0.79 vs 0.82; P &lt; .001). Domains showing improvement were pain and anxiety or depression. A Flemish Triage Risk Screening Tool score greater than or equal to 2 (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.13 to 2.21, P = .007), palliative surgery (OR = 2.14, 95% CI = 1.01 to 4.52, P = .046), postoperative complications (OR = 1.95, 95% CI = 1.19 to 3.18, P = .007) correlated with worsening QoL.

Conclusions
GOSAFE shows that older adults’ preoperative QoL is preserved 3 months after cancer surgery, independent of their age. Frailty screening tools, patient-reported outcomes, and goals-of-care discussions can guide decisions to pursue surgery and direct patients’ expectations.