Presurgery Quality-of-Life Score May Predict Complications

Jenni Laidman

September 05, 2014

Patients awaiting colon cancer surgery who rated their quality of life (QoL) low were 2 and a half times more likely to encounter early, serious surgical complications than those who reported a higher quality of life, a new study shows.

The findings were published online August 5 in the Journal of Gastrointestinal Surgery.

Patients who scored below 50 on a 100-point QoL scale were more likely to experience serious surgical complications than those who scored above 50 (16% vs 6%; = .023), report Juliane Bingener, MD, from the Department of Surgery at the Mayo Clinic in Rochester, Minnesota, and colleagues.

In addition, patients who experienced early complications remained in the hospital 3.5 days longer than those who did not (= .0001).

"The question is, when we see patients with a poor quality of life before surgery, are there things we can do to prepare them for surgery or help them cope afterward?" Dr. Bingener told Medscape Medical News. "Can we intervene and make a difference?"

The 431 patients involved in this analysis were participants in the Clinical Outcomes of Surgical Therapy (COST) trial, a randomized comparison of laparoscopic colon cancer surgery and open resection initiated in 1993.

An earlier analysis of the COST data showed that preoperative QoL scores are associated with overall patient survival and postoperative QoL (Ann Surg Oncol. 2011;18:2422–2431). Other studies have found an association between QoL scores and survival in pancreatic and lung cancer.

Dr. Bingener and colleagues are the first to look at the impact of QoL on surgical complications.

The researchers have begun looking at a wide range of factors that might contribute to cancer survival, including things like physical frailty, Dr. Bingener explained. One trial showed a correlation between core muscle mass and overall and disease-free survival after esophagectomy (Dis Esophagus. 2013;26:716-722).

Evaluating QoL adds the patient perspective to the equation. "Quality of life is something that is self-reported. Patients know things that we may not know about themselves, their environment, their social functioning, their family support, and how they see life and what they do," Dr. Bingener told Medscape Medical News.

There are several interventions that can affect QoL scores, she noted. "There are data looking at exercise — it's a big driver of quality of life. There are guided imagery programs that look at stress reduction. Nutrition may be one factor, anemia another." She reported that she recently launched a pilot study to investigate interventions.

Still, QoL data are not the principal predictor of outcomes, the study results show. "Age clearly trumps it," Dr. Bingener said. "But if you have 2 patients coming in, and both are 80 years old, both have colon cancer, and both have had a heart attack, the one with the good quality of life is more likely to pull through."

QoL is not "merely a proxy for comorbidities"; in fact, hospice patients frequently have high QoL scores, the researchers note. "In the hospice population, patient needs are mostly met to their satisfaction. QoL data may thus provide an assessment of unmet needs, either in the physical, emotional, social, or spiritual domain," they write.

The team reports that an American Society of Anesthesiologist (ASA) score of 3 was significantly associated with early complications, as was a change in activity from baseline to day 14. Predictors of readmission, adjusted for demographic characteristics, tumor stage, ASA score, and operative approach, were preoperative pain (odds ratio [OR], 1.61) and change in fatigue from baseline to day 2 (OR, 1.34).

J Gastrointest Surg. Published online August 5, 2014. Abstract

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