Russell, Marcia M.

BACKGROUND: Older adults value the maintenance of function as an outcome of surgery, which can be evaluated by subjective perception and objective performance. The aims of this study were to explore whether these perceptions correlate with a decline in function, as measured by decreased ability to perform activities of daily living (ADLs), and to identify risk factors associated with worsened 30-day postoperative perceived physical function (PPF) in patients aged 80 years and older. STUDY DESIGN: American College of Surgeons NSQIP Geriatric Surgery Verification Pilot Program data (2015 to 2017) were used for patients aged 80 years and older. Chi-square tests were used to examine the concordance between 30-day outcomes of PPF and the quantified performance of ADLs. Multivariable logistic regression models identified risks associated with worsened PPF 30 days postoperatively. RESULTS: A total of 5,464 patients from 16 hospitals were included. The mean age was 85.7 years and 63% of participants were women. At 30 days postoperatively, 33% reported functional decline, whereas 28% had worsened quantified ADL performance (K = 0.25). Twenty-one percent of patients without quantified decline reported worsened PPF. Risk factors for worsened PPF were found for patient (eg American Society of Anesthesiologists class IV and V (odds ratio [OR] 2.2, 95% CI 1.5 to 3.2)), procedure (eg orthopaedic [OR 1.7, 95% CI 1.2 to 2.4]), and older adult-specific characteristics (eg preoperative fall [OR 1.9, 95% CI 1.2 to 2.9]). CONCLUSIONS: At 30 days postsurgery, there was discordance between quantified ADL performance and PPF in patients aged 80 years and older. Although assessing ADLs is a common approach to detect functional decline and loss of independence, directly asking patients about their PPF can serve as an additional important method for identifying functional decline, ensuring that the evaluation remains patient centered.

PURPOSE Total neoadjuvant therapy (TNT) is a newly established standard treatment for rectal adenocarcinoma. Current methods to communicate magnitudes of regression during TNT are subjective and imprecise. Magnetic resonance tumor regression grade (MR-TRG) is an existing, but rarely used, regression grading system. Prospective validation of MR-TRG correlation with pathologic response in patients undergoing TNT is lacking. Utility of adding diffusion-weighted imaging to MR-TRG is also unknown. METHODS We conducted a multi-institutional prospective imaging substudy within NRG-GI002 (ClinicalTrials.gov identifier: NCT02921256 ) examining the ability of MR-based imaging to predict pathologic complete response (pCR) and correlate MR-TRG with the pathologic neoadjuvant response score (NAR). Serial MRIs were needed from 110 patients. Three radiologists independently, then collectively, reviewed each MRI for complete response (mriCR), which was tested for positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity with pCR. MR-TRG was examined for association with the pathologic NAR score. All team members were blinded to pathologic data. RESULTS A total of 121 patients from 71 institutions met criteria: 28% were female (n = 34), 84% White (n = 101), and median age was 55 (24-78 years). Kappa scores for T- and N-stage after TNT were 0.38 and 0.88, reflecting fair agreement and near-perfect agreement, respectively. Calling an mriCR resulted in a kappa score of 0.82 after chemotherapy and 0.56 after TNT reflected near-perfect agreement and moderate agreement, respectively. MR-TRG scores were associated with pCR ( P < .01) and NAR ( P < .0001), PPV for pCR was 40% (95% CI, 26 to 53), and NPV was 84% (95% CI, 75 to 94). CONCLUSION MRI alone is a poor tool to distinguish pCR in rectal adenocarcinoma undergoing TNT. However, the MR-TRG score presents a now validated method, correlated with pathologic NAR, which can objectively measure regression magnitude during TNT.

The NCCN Guidelines for Older Adult Oncology address specific issues related to the management of cancer in older adults, including screening and comprehensive geriatric assessment (CGA), assessing the risks and benefits of treatment, preventing or decreasing complications from therapy, and managing patients deemed to be at high risk for treatment-related toxicity. CGA is a multidisciplinary, in-depth evaluation that assesses the objective health of the older adult while evaluating multiple domains, which may affect cancer prognosis and treatment choices. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines providing specific practical framework for the use of CGA when evaluating older adults with cancer.