Preoperative assessment of cancer in elderly patients: a pilot study

The aim of this study was to assess the face validity and practical utility of the Preoperative Assessment of Cancer in the Elderly (PACE) tool in a sample of elderly patients with cancer. A prospective series of such patients with breast, colorectal, upper gastrointestinal, and other cancers were interviewed using the PACE; patients were scored for presurgical assessment using standard measures, including American Society of Anesthesiologists physical status, the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM), the Portsmouth POSSUM, and World Health Organization performance status before undergoing standard surgical management. Short-term surgical outcome (in terms of mortality and morbidity) and cancer site-specific data were collected to identify the risk groups. Seventy-two patients took part in the study (participation rate of 97%). The interview in which the questionnaire was given was found to take 20 minutes on average. Face validity was demonstrated, with clear comprehension of the requirements of the PACE being shown by all patients. The 2 groups identified according to the presence (n = 24) or absence (n = 48) of postoperative mortality/morbidity were compared according to components of the PACE. The study identified possible associations between these components and postoperative morbidity. No postoperative mortality was recorded; however, 24 patients (33%) had surgical complications. Performance status and Activities of Daily Living classification were found to be significantly related to postoperative short-term morbidity, whereas a lower score on the Mini Mental State Examination and a higher score on the Geriatric Depression Scale were found to be related to postoperative morbidity, although they did not achieve statistical significance because of the small numbers involved. The authors have demonstrated the practicality and face validity of PACE and identified some associations with postoperative morbidity. Based on the findings of this pilot study, a large, international multicenter trial is planned.