Geriatric assessment domains in relation to treatment outcomes among older adults with colorectal cancer

PROJECT ABSTRACT. About 75% of the newly diagnosed colorectal cancer patients are ≥70 years old and have the lowest 5-year relative survival (61%) due to comorbidity and frailty. Current clinical care guidelines for older cancer patients only partially address specific challenges experienced by them, thus resulting in large variations and inconsistency in their standard cancer care. Evidence surrounding complications after colorectal cancer surgery, treatment toxicity, and their impact on patients’ quality of life (QoL) in older colorectal cancer patients is inconsistent, and relies heavily on the chronological age of the patient. Thus, there is an urgent unmet need to evaluate predictors of clinical and patient-reported outcomes in older colorectal cancer patients in order to aid clinical decision-making and tailor treatment regimens that coincide with patients’ level of risk, while minimizing complications and toxicities, and improving QoL. The current project is prepared in response to NIH NOSI NOT-CA-21-031, and will help inform the role of aging-related functional decline on various clinical and QoL outcomes in cancer patients. The overall objective of this project is to evaluate whether physical function (Aim 1), a multidimensional brief geriatric assessment tool (Aim 2), and pre-operative biomarkers of aging (telomere length, mitochondrial DNA copy number), inflammation, nutritional status and a biological aging score (Aim 3) are associated with postsurgical complications, treatment toxicity, survival, QoL, and cognitive outcomes in geriatric colorectal cancer patients. Our central hypothesis is that outcomes in geriatric colorectal cancer patients are associated with physical, functional, emotional, and cognitive status, irrespective of patients’ chronological age. We propose to recruit a prospective cohort of newly diagnosed stage I-III colorectal cancer patients (n~462) ≥70 years of age recruited ~2 weeks prior to their cancer surgery. At study enrollment, we will assess patients’ physical function through Short Physical Performance Battery and Handgrip testing, and administer a brief geriatric assessment tool developed by Hurria et. al. Biomarkers of biological aging, inflammation, and nutritional status will be measured in stored blood collected prior to surgery using well-validated assays. Associations of these exposures with surgical complications (at 30 days), treatment toxicity, QoL and cognitive function (at 12 months), and clinical outcomes such as survival (at 24 months) will be measured. Our proposed study design is cost-effective as it builds upon a well-established unique cohort currently recruiting colorectal cancer patients <70 years of age, the ColoCare Study. The healthcare of older cancer patients extends beyond the traditional management of cancer, and requires addressing the multifactorial health concerns of this expanding population, making it a significant public health priority. Information gained in this project may ultimately inform precision geriatric oncology approaches to improve clinical and patient-reported outcomes in patients at a higher risk of chemotoxicity and death, and to tailor risk stratification for cancer surveillance in this growing population of geriatric colorectal cancer survivors.