Advertisement

Comorbidity, Disability, and Geriatric Syndromes

  • Siri Rostoft KristjanssonEmail author
Chapter

Abstract

Comorbidity is defined as the presence of one or more disorders in addition to colorectal cancer. Comorbidity plays a role in a patient’s individual risk of ­mortality and morbidity and may influence tolerance to cancer therapy. A comorbidity assessment is necessary to answer the following questions: Is the patient’s remaining life expectancy likely to be limited by the colorectal cancer or by another comorbid medical condition? Will the comorbid condition(s) affect treatment tolerance? What are the interactions between the comorbid medical conditions and colorectal cancer?

Keywords

Colorectal cancer Frailty Comorbidity Geriatric assessment Physiological reserves Life expectancy Competing risk Older cancer patients Geriatric syndromes 

References

  1. 1.
    Welch HG, Albertsen PC, Nease RF, Bubolz TA, Wasson JH. Estimating treatment benefits for the elderly: the effect of competing risks. Ann Intern Med. 1996;124(6):577–84.PubMedGoogle Scholar
  2. 2.
    Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel Jr EL. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291(20):2441–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol. 2004;22(15):3099–103.PubMedCrossRefGoogle Scholar
  4. 4.
    Gross CP, Guo Z, McAvay GJ, Allore HG, Young M, Tinetti ME. Multimorbidity and survival in older persons with colorectal cancer. J Am Geriatr Soc. 2006;54(12):1898–904.PubMedCrossRefGoogle Scholar
  5. 5.
    Lemmens VE, Janssen-Heijnen ML, Houterman S, et al. Which comorbid conditions predict complications after surgery for colorectal cancer? World J Surg. 2007;31(1):192–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Kristjansson SR, Jordhøy MS, Nesbakken A, et al. Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol. 2010;1(2):57–65.CrossRefGoogle Scholar
  7. 7.
    Zingmond D, Maggard M, O’Connell J, Liu J, Etzioni D, Ko C. What predicts serious complications in colorectal cancer resection? Am Surg. 2003;69(11):969–74.PubMedGoogle Scholar
  8. 8.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRefGoogle Scholar
  9. 9.
    Ouellette JR, Small DG, Termuhlen PM. Evaluation of Charlson-Age Comorbidity Index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg. 2004;8(8):1061–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Rabeneck L, Davila JA, Thompson M, El-Serag HB. Outcomes in elderly patients following surgery for colorectal cancer in the veterans affairs health care system. Aliment Pharmacol Ther. 2004;20(10):1115–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Rutten HJ, den Dulk M, Lemmens VE, van de Velde CJ, Marijnen CA. Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol. 2008;9(5):494–501.PubMedCrossRefGoogle Scholar
  12. 12.
    Audisio RA, Pope D, Ramesh HS, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65(2):156–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Panis Y, Maggiori L, Caranhac G, Bretagnol F, Vicaut E. Mortality after colorectal cancer surgery: a French survey of more than 84,000 patients. Ann Surg. 2011;254(5):738–43; discussion 743–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Gross CP, McAvay GJ, Krumholz HM, Paltiel AD, Bhasin D, Tinetti ME. The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: implications for screening. Ann Intern Med. 2006;145(9):646–53.PubMedGoogle Scholar
  15. 15.
    Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “she was probably able to ambulate, but I’m not sure”. JAMA. 2011;306(16):1782–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346(14):1061–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Sunouchi K, Namiki K, Mori M, Shimizu T, Tadokoro M. How should patients 80 years of age or older with colorectal carcinoma be treated? Long-term and short-term outcome and postoperative cytokine levels. Dis Colon Rectum. 2000;43(2):233–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Gurevitch AJ, Davidovitch B, Kashtan H. Outcome of right colectomy for cancer in octogenarians. J Gastrointest Surg. 2009;13(1):100–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285(23):2987–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003;58(1):82–91.PubMedCrossRefGoogle Scholar
  22. 22.
    Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199(5):762–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Kehlet H. Fast-track colorectal surgery. Lancet. 2008;371(9615):791–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Martin FC, Brighton P. Frailty: different tools for different purposes? Age Ageing. 2008;37(2):129–31.PubMedCrossRefGoogle Scholar
  26. 26.
    Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5(3):224–37.PubMedCrossRefGoogle Scholar
  27. 27.
    Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc. 2004;52(11):1929–33.PubMedCrossRefGoogle Scholar
  29. 29.
    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Ensrud KE, Ewing SK, Taylor BC, et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Kristjansson SR, Ronning B, Hurria A, Skovlund E, Jordhøy MS, Nesbakken A, Wyller TB. A comparison of two pre-operative frailty measures in older surgical cancer patients. J Geriatr Oncol. 2012;3(1):1–7.CrossRefGoogle Scholar
  32. 32.
    Tan KY, Kawamura YJ, Tokomitsu A, Tang T. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg. 2012;204(2):139–43.PubMedCrossRefGoogle Scholar
  33. 33.
    Baillargeon J, Kuo YF, Lin YL, Raji MA, Singh A, Goodwin JS. Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011;59(7):1268–73.PubMedCrossRefGoogle Scholar
  34. 34.
    Gupta SK, Lamont EB. Patterns of presentation, diagnosis, and treatment in older patients with colon cancer and comorbid dementia. J Am Geriatr Soc. 2004;52(10):1681–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Internal MedicineDiakonhjemmet HospitalOsloNorway

Personalised recommendations