THE EFFECT OF FRAILTY ON RECTAL CANCER OUTCOMES; CALL TO ACTION.
Jakub Wlodarczyk*2,1, Lawrence Brown2, Oluwafemi P. Owodunni2, Susan Gearhart2
1Uniwersytet Medyczny w Lodzi, Lodz, Lodzkie, Poland; 2Johns Hopkins Medicine, Baltimore, MD
Introduction: Rectal cancer is a leading cancer diagnosis in the US, and the number of older patients diagnosed with this disease is expected to rise. Locally advanced rectal cancer (LARC) is commonly treated with consolidation neoadjuvant chemoradiation with the goal of organ preservation. However, frailty is not often recognized or considered in the treatment algorithm for rectal cancer. The prevalence of frailty in Medicare beneficiaries with cancer has been reported to approach 50% and the treatment of frail older cancer patients is complex and challenging. In the current study, we assessed the impact of frailty on the early postoperative outcomes of frailty among rectal cancer patients.
Methods
This retrospective, propensity score-matched study was conducted by extracting patients from the institutional's rectal cancer database and merging with the institutional's NSQIP registry. Patient characteristics included demographics, neoadjuvant therapy, time on neoadjuvant therapy, time to surgery, surgical approach, and oncological staging. Frailty was assessed using the Modified Frailty Index (mFI). Outcomes include loss of independence (LOI) or need for increased support outside the home, length of stay, and major complications (Clavien-Dindo II-IV). For analysis, patients were matched for frailty status, contingent on sex, race, chemoradiation, and procedure approach.
Results
129 patients operated on due to LARC from 2010 to 2021 were identified and in this group, 27 (21%) were frail. Neoadjuvant chemoradiotherapy was given at a similar rate in frail and non-frail patients (70% vs. 70.6%). No significant differences were observed in the surgical approach (Robotic 22% vs. 35%, p=0.25), the R0 resection rate (85% vs. 92%, p=0.29), and complete pathologic response rate (22% vs. 27%, p=0.81) in frail and non-frail patients, respectively. On propensity matched analysis, rectal cancer treatment outcomes in frail patients were associated with longer hospitalization time (OR=1.67; 95%CI 1.5-1.9; p<0.001) and a higher rate of major complications (OR=3.21; 95%CI 1.4-7.5, p=0.007). Frail patients had a significant increase in LOI (OR=2.14; 95%CI 1.4-3.2; p<0.001)
Conclusions
Frail patients undergo similar multimodal treatment for rectal cancer as non-frail patients and have poor postoperative outcomes. Further studies are necessary to examine the effect of this treatment paradigm on long-term cancer specific outcomes in the frail older patient so that properly balanced treatment strategies can be established.
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