A specially developed scorecard to assess the condition of elderly patients with cancer makes it easier for doctors to determine the risks of an operation. This makes it easier to identify which patients are fit enough for an operation and for which patients the operative risk is too great. This will make it easier for doctors to prepare their patients for the outcome of an operation and to take steps to prevent any problems. These are the findings of the doctoral thesis of Monique Huisman from the University Medical Center Groningen. She will be awarded her PhD at the University of Groningen on 4 July.
With the population ageing, the number of older patients with cancer is increasing fast. For many, an operation is part of their treatment. Before such an operation takes place the surgeon must estimate the risk of complications and weigh this up against the expected health benefits of an operation. Elderly people with poor physical and nutritional health are at greater risk of complications after cancer surgery. This risk used to be based on age, but age is not a reliable predictor.
In her research, Monique Huisman shows that elderly people with cancer often experience complications after surgery. One in five patients developed serious complications and over a quarter were admitted to a nursing or care home. Two years after the operation almost half of the patients had died or been admitted to a nursing or care home.
Specially developed scorecard
For her research, Huisman developed a scorecard (the PREOP score) to predict the risk of serious complications. She included factors such as sex, type of operation, functionality and nutritional status. This scorecard proves to be a good indicator of the risk of complications. Ninety-four percent of the patients with a good score did not suffer from severe complications after the operations, whereas in patients with a bad score only 60% did not suffer from severe complications. The number of patients still living a year later was much higher for the patients with a good score than for those with a bad score.
Easier to identify at-risk patients
Huisman believes that the scorecard makes it easier to identify patients for whom the risk might be too great to operate. And by the same token it gives better confirmation that someone is fit enough for an operation. Huisman believes that it will also make it possible to select patients at risk, who might benefit from a special programme to increase their fitness level before the operation, thus reducing the chance of complications.
Huisman calls on surgeons to devote extra attention to people with a poor score. The PREOP scorecard is easy to complete and is a good way to help them estimate the risk of surgery. This means they can provide more tailored care.
Monique Huisman (1989) studied Medicine at the University of Groningen. She conducted her research at the departments of Epidemiology and Surgical Oncology at the University Medical Center Groningen. Her research ties in with the research theme of Dr B.L. van Leeuwen, who is studying pre-, peri- and postoperative factors that influence the postoperative history of elder surgical patients. Huisman is now training as a surgeon at ZGT in Almelo and Hengelo. The title of her doctoral thesis is: ‘Preoperative risk assessment of adverse outcomes in onco-geriatric surgical patients’.