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