Frailty of elderly patients after surgery

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Published: 22 Nov 2018
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Dr Suzanne Stokmans - University of Groningen, Groningen, The Netherlands

Dr Suzanne Stokmans speaks to ecancer at the International Society of Geriatric Oncology 2018 conference in Amsterdam about frailty in older cancer patients.

In her study, she found that patient frailty didn't change after surgery, when it was expected that their frailty would decrease.

Dr Stokmans describes the way frailty is measured, both physical and cognitive - however with an emphasis on the importance of a more quantitative scale.

This service has been kindly supported by an unrestricted grant from Janssen Oncology.

My interest is mainly in frailty in older cancer patients and in the SIOG meeting two years ago we talked about the evolution of frailty when we looked at patients before and after surgery. Then we presented the results and it seemed that the surgery didn’t make patients less frail which is a thought that is common amongst surgeons because they see a patient in the outpatient clinic who is frail and they think the surgery might change it and the patient might be doing a lot better after the surgery.

But we didn’t find that in our group of patients that we studied. We found that the frailty didn’t actually change after the surgery so that’s why we decided that in March of this year, after a follow-up period of 41 months, to check again on the patients and to send them again the list, the frailty list, the Groningen Frailty Indicator is what we use for that, and to check on them to see how the frailty evolved over time. Then we found that still a lot of patients were frail but in a quarter of patients there was actually a frailty switch, so some of them were non-frail at the treatment of surgery but they were frail now and some of them were frail after surgery but non-frail now. But most patients actually just stayed frail or non-frail so that’s what we discovered.

How many patients were involved?

There were 343 patients at the baseline measure but now in March 2018 174 patients.

Can you describe the frailty measure?

Actually we used the Groningen Frailty Indicator and it’s a subjective skill because it’s only questions so there are no measurements actually. So we don’t measure any functional measures like hand grip strength or time, we didn’t measure that. We only asked them fifteen questions and those questions are about daily activities, health problems and psychosocial functioning.

Is there a question about cognitive function?

Yes, it has one question and that question is about do you forget things easily in the past month.

Are there any assessments this can be double checked against?

Yes, I think that’s important because this is only a general idea. But functional tests are actually more important so I’m looking forward to studies which, for example, use prehabilitation or rehabilitation to actually work on patients’ physical functioning and stuff. I think it would be very interesting to check that as well because that’s what also matters of course.

Would a registry for that data be useful?

Yes, it would be very useful and some hospitals do it regularly. They fill in checklists regularly but we don’t have those kinds of numbers right now.