Comanagement with Geriatricians and Surgeons May Improve Mortality in Operative Older Cancer Patients

When it comes to older cancer patients, teamwork makes the dream work: a comanagement approach between geriatricians and surgeons may help improve mortality in older cancer patients who must undergo surgery, according to a study.

“Geriatric comanagement of care is characterized by collaboration between geriatrics and nongeriatrics teams, with a focus on the prevention and management of geriatric syndromes and complications. A key component of geriatric comanagement is the geriatric assessment, which can be used to identify frailty and risk factors among older patients that are not always apparent during general preoperative assessment,” the researchers explained.

They conducted a retrospective cohort study comparing patients who did versus did not receive geriatric comanagement care for 90-day mortality. Patients aged 75 years and older at a single tertiary-care center between February 2015 and February 2018 were eligible for inclusion. Adjustments were made for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. Comanagement and management only by surgeon patients were also compared for adverse surgical events including any major complication, readmission, or emergency department (ED) visit within 30 days.

Final analysis included 1,892 patients, of whom 1,020 (53.9%) received geriatric comanagement of care; 47.8% (n=488) of the comanaged group and 51.6% (n=450) of the surgery service only group was male. Comanagement patients were older than those who were only managed by the surgery service (mean [SD] age, 81 [4] years vs. 80 [4] years; P<0.001); they also had longer operative time (mean [SD], 203 [146] minutes vs. 138 [112] minutes; P<0.001) and length of story (median [interquartile range], 5 [3–8] days vs. 4 [2–7] days; P<0.001). The risk for adverse surgical events did not largely differ between the groups (odds ratio=0.93; 95% confidence interval [CI], 0.73 to 1.18; P=0.54), but the adjusted 90-day mortality risk was significantly lower in the comanagement group than the surgery service only group (4.3% vs. 8.9%; difference, 4.6%; 95% CI, 2.3% to 6.9%; P<0.001). Patients in the surgery service only group, compared to the geriatric comanagement group, had a lower proportion of patients who received physical therapy (555 patients [63.6%] vs. 820 patients [80.4%]; P<0.001), occupational therapy (220 patients [25.2%] vs. 385 patients [37.7%]; P<0.001), speech and swallow rehabilitation (42 patients [4.8%] vs. 86 patients [8.4%]; P=0.002), and nutrition services (637 patients [73.1%] vs. 803 patients [78.7%]; P=0.004).

The study was published in JAMA Network Open.

“Geriatric comanagement may improve patients’ ability to survive adverse postoperative events. This finding should be assessed in the future by conducting randomized clinical trials,” the study authors concluded.