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Perioperative Care in Older Adults with Cancer and Frailty

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Frailty in Older Adults with Cancer

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Abstract

Current projections indicate that by 2030, one-fifth of people in England aged above the age of 75 years and older will undergo surgery each year. Many will undergo cancer surgery and a significant proportion will have frailty. Studies consistently show that pre-existing frailty is associated with higher complication and all-cause mortality rates in surgical patients. This has led to the development of the POPS (perioperative care of older people undergoing surgery) model of care which underpins a paradigm shift in the way surgery in the elderly is managed. POPS encompasses care from preoperative assessment, through surgery to discharge and beyond. The main pillar of POPS is the delivery of perioperative care based on comprehensive geriatric assessment. Elective surgery assessment generally takes place in multidisciplinary pre-assessment clinics with the involvement of anaesthetists, surgeons, geriatricians, nurses and allied healthcare professionals. Preoperative assessment provides the basis for preoperative optimisation of physiological reserve, comorbidities, geriatric syndromes, as well as the planning of postoperative optimisation. Ward-based components of the proactive care of POPS encompass all aspects of the postoperative assessment and optimisation of an older person with frailty who has undergone emergency or elective surgery, including discharge planning. This chapter will discuss the implications of frailty, risk stratification, relevant investigations, as well as the multidisciplinary perioperative care required to manage the older adult with frailty undergoing cancer surgery.

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Authors and Affiliations

  1. Elderly Medicine Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Sherena Nair

  2. Leeds Institute of Medical Research, University of Leeds, Leeds, UK

    Simon J. Howell

  3. Anaesthesiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Simon J. Howell

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  1. Sherena Nair
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  1. Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK

    Fabio Gomes

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Nair, S., Howell, S.J. (2022). Perioperative Care in Older Adults with Cancer and Frailty. In: Gomes, F. (eds) Frailty in Older Adults with Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-89162-6_13

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