Better Be on Top

In this study, we will identify frailty in older colorectal cancer patients on six domains: physical performance, nutritional status, anemia, psychosocial, cognitive and smoking status. In case of frailty, patients will start with prehabilitation and rehabilitation to increase the preoperative and postoperative capacity and reduce the impact of surgery.

As the incidence of colorectal cancer (CRC) is increasing with age and several surgical developments have been made the past few years, the number of older patients receiving surgical treatment is increasing. However, the impact of surgery should not be underestimated in the older CRC patients. Especially the frail older CRC patients have higher
mortality and postoperative complication rates in comparison to the non-frail patients. Identifying and modifying vulnerabilities before and after surgery may increase the capacity and decrease the impact of surgery. Evidence of prehabilitation with or without the combination of rehabilitation is limited and inconsistent due to studies with small
sample sizes and the inclusion of non-frail patients. This means that a large cohort study is needed to establish the effect of prehabilitation and rehabilitation in frail older CRC patients.

Inclusion, baseline measurements, preoperative frailty evaluation, postoperative physcial test at 3, 6 and 12 months , postoperative evaluation of Qol and ADL at 6 and 12 months.

Included patients will be screened for frailty on physical performance, nutritional status, anaemia, psychosocial, cognitive and smoking status. The physiotherapist will screen for physical frailty, the dietician for nutritional fraitly, the geriatrician for cognitive and psychosocial frailty and the surgeon for anaemia and smoking status. Only in case of frailty - defined by clear cut off points- interventions are initiated. Potential interventions are: four — six week exercise program, protein or energy supplements, iron infusion in case of proven iron deficiency anaemia, delirium preventing strategies, psychologic consultation and smoking cessation.