Colorectal Cancer In The Elderly

An elderly patient being diagnosed with colorectal cancer is not uncommon as many countries, including ours, face a dramatic increase in the number and proportion of the elderly with vastly improved life expectancies.

An elderly patient, however, often faces many different challenges:

Elderly patients may have many concurrent illnesses such as diabetes, heart conditions, hypertension and other chronic illness
The elderly often has a common geriatric syndrome known as "Frailty" whereby there is diminished strength, endurance and reduced physiological reserves. These may increase the risk of complications from surgery due to an inability to mount an adequate response to stressors from surgery.
Furthermore, as many patients are very old, the benefit of surgery may not be clear-cut to the family members and even the surgeons, as the life span of the patient may not outlive the cancer.

Dr Chew Min Hoe has had extensive experience while in the public sector, managing many elderly patients. He has also devoted considerable time in research and improvements in care plans for the elderly. In addition, he has led a Programme for Enhanced Elderly Recovery which has performed prehabilitation for 100 patients before surgery, thereby reducing post-operative problems as well as increasing the ability to be discharged home rather than to community care facilities. He has had a good understanding of the holistic care required and has demonstrated good results. He has also performed more than 20 surgeries for patients older than 90 years old.

WHEN AND WHY IS SURGERY RECOMMENDED?

There are considerable misconceptions that having medical conditions equates to frailty and disability. This is incorrect. Many patients with medical conditions are, in fact, able to maintain good health and fitness with good disease management. Furthermore, frailty is reversible and can improve over time.

Many elderly patients often remark "I am so old; I am not keen to subject myself to an operation as I am likely to pass away first." While it is hard to predict the actual duration of lifespan of any individual, we understand that in Singapore, many live well beyond 80 years old.

Many times, the diagnosis of the cancer is made as the symptoms have prompted the elderly patient to seek medical attention after a long time. It can often be after considerable delay as the patient did not wish to trouble his/her family members. Left untreated, these symptoms can be distressing as it often wakes the patient up from sleep, can be relentless and progressive in intensity as the cancer grows, and often causes the family members to be highly anxious and often affects the mental well-being of everyone caring for the patient at home. Subsequently, after declining and observing over a period of time before finally seeking help for the cancer and requesting for surgery, the surgeon often finds that patient is just too unwell or too physically deconditioned that surgery is no longer safe and has limited success.

Surgery will be recommended once a careful assessment, individualized evaluation of treatment goals, and communication of realistic outcomes are done. Surgery may be performed once medical conditions are optimized and a possible short duration of prehabilitation of physiotherapy and nutritional improvement if needed.

WHAT CAN ELDERLY PATIENTS EXPECT?

PREOPERATIVELY:

Our team will coordinate and organise the following:

Multi-disciplinary team evaluation and discussions. This will be dependent on the chronic medical conditions that the patient has. An evaluation of fitness for general anaesthesia may also involve a cardiac screen, especially if no previous screen has been done before.
Prehabilitation may be required if the patient is assessed to have some degree of frailty. This may include a series of activities and exercises, nutritional supplementation and a repeat assessment thereafter to ensure physical improvement.

RECOVERY:

Once deemed suitable for discharge, physical activity and exercises as well as nutrition advice will be provided to avoid further deconditioning.
Aids and home modifications may be advised to prevent problems such as falls while at home.
Caregiver teaching and guidance will be provided by our medical team.

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