Impact of Frailty on Outcomes in Colorectal Cancer

Abstract

Aim: The aim of the thesis is to describe the prevalence of frailty among older adults diagnosed with colorectal cancer (CRC) in Sweden, to explore how age and frailty influence postoperative outcomes, including mortality, complications, quality of life (QoL) and functional outcomes, and to investigate how frail older adults experience CRC treatment. Methods: Papers I and II used data from the Swedish Colorectal Cancer Registry (SCRCR) including patients who underwent CRC surgery in Region Västra Götaland, Sweden, between 2016-2020. Paper I compared postoperative outcomes between patients < 70 years and those ≥ 70 years. Paper II included retrospective frailty assessments of a randomly selected cohort of older patients, comparing outcomes between frail and non-frail individuals. Paper III was a qualitative interview study exploring the experiences of frail older adults who had received standard care and surgery for CRC. Paper IV analysed patient-reported outcomes from a prospective cohort of patients aged ≥ 70 years, comparing QoL and functional outcomes between frail and non-frail individuals. Paper V presents the study protocol for a randomised controlled trial evaluating comprehensive geriatric assessment (CGA) prior to elective CRC surgery. Results: Older age was associated with increased postoperative mortality (Paper I). The frailty prevalence in Paper II was 56% and frail older adults had higher mortality rates and longer hospital stays than non-frail peers. Paper III showed that frail patients viewed surgery as necessary for survival and considered the treatment worthwhile despite postoperative challenges. Paper IV found no significant differences in QoL or treatment-related effects on daily activities at one-year follow-up between frail and non-frail patients. Conclusion: Advanced age and frailty are independent risk factors for postoperative mortality after CRC surgery. Frailty is common among older adults, who nevertheless regard surgery as inevitable and generally report preserved QoL among survivors. Future efforts should focus on reducing postoperative mortality in this vulnerable population.