Functional recovery in older women undergoing surgery for gynaecological malignancies: A systematic review and narrative synthesis. Issue 7 (September 2020)

• Record Type: Journal Article
• Authors: Martin, Fionna E; Kalsi, Tania; Baker, Holly; Bharathan, Rasiah; Sbai, Magda; Partridge, Judith S.L.; Dhesi, Jugdeep K.
• Is Part Of: Journal of geriatric oncology. Volume 11:Issue 7(2020)
• Page Start: 1087
• Page End: 1095
• Publication Date: 2020-09
• Subjects: Gynaeoncology surgery -- Geriatric oncology -- Functional outcomes -- Activities of Daily Living (ADLs) -- Patient-reported outcome measures (PROMS) -- Shared-decision making; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2020.06.006
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Objectives: Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. This systematic review and narrative synthesis describes functional recovery after gynaeoncology surgery with respect to baseline characteristics. Materials and Methods: Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974 to 2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria: - mean/median patient age >60 - gynaeoncology surgery - preoperative, post-operative and change in function evaluated using any validated tool containing items measuring functional ability (defined by WHO International Classification of Function). Results analysed and presented using narrative synthesis. Results: Fifteen studies identified (8 Endometrial, 2 Ovarian, 2 Vulval, 3 mixed cancer types). 1/15 used a standalone functional assessment tool, 14/15 used Health-Related Quality of Life tools (EORTC QLQ C30 (8), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline ( n = 13) than incomplete recovery ( n = 2). Four studies reported a negative association between older age and functional trajectory. Recovery was more likely and occurred faster in minimally-invasive surgery. Few studies reported baseline characteristics including cognition, frailty or comorbidities and none examined associations with functional recovery. Conclusion: There is inadequate data on functional recovery of older women following gynaeoncology surgery. Future studies are needed to identify factors associated with poorer/better outcomes. This may enable identification of opportunities for risk reduction, improve equity of access and better shared-decision making. Highlights: Anticipated functional outcome influences older women's treatment choices. Lesser functional decline often associated with minimally invasive surgery. Older age & low baseline function negatively impact postoperative functional return. Frailty, multimorbidity and cognition not routinely measured in existing research. Future research may identify potential targets for intervention and improvement.