Short summary

Advanced age is associated with a decline in functional ability and an increase in morbidity, including risk of cancer. A growing number of older patients are diagnosed with cancer of the gastrointestinal tract. The objectives of this study is to investigate the variance of physical frailty, disability and comorbidity in older patients (70 years or more) with gastrointestinal cancer receiving chemotherapy and their perceived need for rehabilitation with the overall aim being improved functional capacity and quality of life.

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Rationale

Advanced age is associated with a decline in functional ability and an increase in morbidity, including risk of cancer. A growing number of older patients are diagnosed with cancer of the gastrointestinal tract. Less than 50% are cured by surgery and there will be a need for further treatment with chemotherapy. Knowledge on functioning and rehabilitation needs throughout the course of treatment is lacking, as the topic has been sparsely investigated and because older cancer patients are underrepresented in clinical trials. 

The objectives of this study is to investigate the variance of physical frailty, disability and comorbidity in older patients (70 years or more) with gastrointestinal cancer receiving chemotherapy and their perceived need for rehabilitation. The aim is to improve functional capacity and quality of life in older patients with cancer of the gastrointestinal tract by identifying explaining factors related to functioning and rehabilitation needs.

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Description of the cohort

Older patients with gastrointestinal cancer 70 years or more, who are offered treatment with chemotherapy in either adjuvant or palliative setting, in an out-patient oncologic clinic at the University Hospital of Odense, Denmark.

The clinic treats various types of cancer in the gastrointestinal tract: Esophageal, stomach, pancreatic, gallbladder, GIST tumors, colon and rectal. The chemotherapy is given with different purposes: pre- or postoperative adjuvant, downstaging aiming at tumor resection or palliative, where patient may receive several lines of therapy.

Data and biological material

Patients, nurses, doctors and physiotherapists cooperate on baseline assessment, re-evaluation after 2 months of chemotherapy and at the end of a line of chemotherapy. The patients will be evaluated with the following standardized screening- and assessment tools:

• G-8 is an eight-item screening tool found to have great potential for identifying cancer patients with a geriatric risk profile.
• VES-13 is a 13-item self-administered tool used to identify older patients with increased risk of health deterioration in the general population based on age, self-rated health and the ability to perform functional and physical activities.
• Timed-Up-and-Go (TUG) is used to assess the functional status of the older patient. The patient is observed and timed while getting up from an arm chair, walking 3 meters, turning, walking back, and sitting down again.
• Hand Grip Strength (HGS) is measured with a hand dynamometer and is used as a measurement for overall strength.
• Charlson Co-morbidity Index (CCI) is a scoring system that classifies patients into 3 groups of mortality.
• Quality of life (QoL) will be assessed by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core Questionnaire (EORTC QLQ-C30) and the subscale for older patients (EORTC QLQ-ELD14).
• Frailty is in the present project operationalized according to the five criteria defined by Fried and colleagues: Unintentional weight loss, exhaustion/poor endurance, low level of physical activity, motor slowness and muscular weakness. Score range from 0 to 5, 1-2 is considered pre-frail, and a score above 3 as frail.
• Patients' perceived rehabilitation needs is assessed by using two methods; a systematic assessment of rehabilitation needs, performed by oncologic nurse as stipulated by national policies and guidelines and semi-structured interviews carried out among approximately 16 patients to enlighten perceived needs for rehabilitation during and at the end of a course of chemotherapy. A strategic selection of participants will take place in regards of both genders and patients living alone/not living alone.

Collaborating researchers and departments

The study is a collaboration between the Department of Rehabilitation and the Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odenseand is grounded in an interdisciplinary interest for the aging cancer patient and will contribute to this very focus within the well-established Elite Research Center, AgeCare, Academy of Geriatric Cancer Research, Department of Oncology, Odense University Hospital.

Department of Rehabilitation, Odense University Hospital

• Physiotherapist and postdoctoral researcher Eva Jespersen, PhD 
• Physiotherapist Lisbeth Minet, PhD

Department of Oncology, Odense University Hospital

• Professor Per Pfeiffer, MD, PhD 
• PhD-student Stine Brændegaard Winther, MD
• Camilla Qvortrup, MD, PhD

Department of Geriatric Medicine, Odense University Hospital

• Jesper Ryg, MD, PhD