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Deep Dive into a Collaboration that can Save Lives of Older Adults with Cancer after Surgery
Jun 24, 2025
Surgery in older adults with cancer is complex. Older patients are at much higher risk of dying compared to younger patients. A collaboration between geriatricians and oncologic surgeons may change that, and may give older patients with cancer a much better chance of surviving the cancer surgery. We will have a deep dive into a study that explored this.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769503
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you know when an older loved one has to
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face major surgery especially with
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cancer involved well it brings just a
0:11
huge amount of anxiety doesn't it oh
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absolutely it's completely
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understandable we all know surgery is
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tough physically demanding but for
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someone say 75 or older that worry about
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how they'll recover but all the risks
0:23
involved it just feels
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amplified significantly it really is
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there's that very real concern about
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their um their physiological reserve how
0:34
is their body actually going to cope
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with the huge stress of an operation and
0:39
then bouncing back afterwards exactly
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and often you're just so focused on the
0:44
surgery itself right just hope they get
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through that part okay but what if um
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what if a a key part of getting a better
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outcome wasn't just the procedure but
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really how you prepare for it and how
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you support the whole recovery process
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well that's getting right to it like
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what if there was actually a way to
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significantly cut the risk of the worst
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outcomes and that's precisely what makes
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the research we're uh digging into today
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so compelling and actually really
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hopeful we're looking at a study it was
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published in JAMAN network open from
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researchers over at Memorial Sloan
1:14
Kettering Cancer Center right mskcc so
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let's unpack this source our mission for
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this deep dive is basically to
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understand what they found about this
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specific approach they call it geriatric
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commandment that's the term yeah and
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figure out what it could actually mean
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for older adults who are facing cancer
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surgery maybe you know for you listening
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or someone you care about so okay
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geriatric management at its core um it's
1:40
about adding specialists in aging
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geriatricians and making them a central
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part of the surgical care team okay that
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makes sense because well older adults
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aren't just scaled up versions of
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younger patients are they not at all
1:52
their bodies handle things differently
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medications anesthesia they're often
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more prone to things like confusion
1:59
afterwards
2:00
delirium bones might be more fragile
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nutrition is a big factor all of that
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and recovery from a huge stressor like a
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major operation it just needs a
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different kind of tailored support so
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the geriatrician they're the expert
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trained specifically to understand and
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you know navigate all those complexities
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they don't just see the cancer or the
2:20
operation in isolation they see the
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whole person exactly the whole person
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their thinking their nutrition how well
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they move all the medications they might
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be on their support system at home all
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of it and it's a team thing you said
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before and after yeah very much team-
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based applied both before the surgery
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trying to get the patient in the best
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possible shape and then critically after
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the surgery to really support that
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recovery phase okay so the
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million-dollar question for this study
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then was does adding this specialized
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sort of holistic expertise into the mix
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actually change the outcome like life or
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death outcomes for these older cancer
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patients that was the core question to
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find out the researchers did what's
3:00
called a retrospective cohort study so
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they looked back at patient records okay
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they examined data from uh nearly 1,900
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patients all of them were 75 or older
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and all had cancer related surgery at
3:12
Memorial Sloan Kettering between 2015
3:14
and 2018 wow that's a lot of patients
3:16
and how did they compare them well they
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effectively had two groups based on the
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care they got one group the larger one
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just over a,000 patients received this
3:26
geriatric management we're talking about
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right and the other group about 870
3:30
patients they received the standard
3:32
surgical care managed just by the
3:34
surgical team itself got it and what
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were they measuring what was the key
3:38
outcome the main thing they looked at
3:40
was uh pretty stark it was mortality
3:44
death within 90 days after the surgery
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okay 3 months and this is where it gets
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really interesting this is where it gets
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frankly quite dramatic now they did
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statistical adjustments first ah right
3:55
to account for differences between the
3:57
groups exactly things like you know the
3:59
patients specific age their sex how
4:02
frail they were assessed to be before
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surgery the type and complexity of the
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operation even how much blood was lost
4:08
they tried to level the playing field
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statistically okay good so after
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adjusting for all that what did they
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find so for the group that got care only
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from the surgical service the adjusted
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probability of dying within those 90
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days was 8.9% okay nearly 9% which
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sounds high it reflects the risks for
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this population undergoing major surgery
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but then you look at the group that had
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the geriatric management that number
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dropped it plummeted really to just 4.3%
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wow wait from 8.9 down to 4.3 that's
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right a reduction of 4.6 percentage
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points after adjustment it essentially
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means they cut the risk of death within
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90 days almost in half for the patients
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who got that specialized geriatric
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support that is that's huge that's a
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massive difference it is they even
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calculated something called the number
4:53
needed to treat what's that tell us it
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was 22 which suggests based on this
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study that for every 22 older cancer
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patients who received this
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commandagement approach one death within
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that 90-day window might have been
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prevented just think about that for
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every 22 people one life potentially
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saved in those crucial first months that
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feels incredibly powerful for surgery in
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this age group it really does and what's
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especially fascinating is trying to
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figure out how how did this approach
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make such a big difference in survival
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yeah what was the mechanism particularly
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because the study found that the rates
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of like immediate postsurgical problems
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big complications trips back to the ER
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getting readmitted to the hospital
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within 30 days those rates were actually
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pretty similar between the two groups
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wait hold on so the geriatric team
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wasn't necessarily stopping the
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immediate surgical complication rate
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from happening apparently not
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significantly no but they were stopping
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people from dying in the weeks and
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months after how does that work that
5:56
seems a bit backwards well that's the
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really key insight isn't it it seems to
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point away from just the technical
6:01
success of the operation itself and more
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towards the absolute critical importance
6:06
of the recovery process especially for
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older adults okay and the study gave us
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a big clue it highlighted what did
6:12
differ significantly between the groups
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which was patients in that geriatric
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management group they received
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substantially more inpatient supportive
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care services supportive care like what
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kind of things things like physical
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therapy uh 80% of the commanded group
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got PT compared to only 63% in the
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surgery only group big difference yeah
6:34
occupational therapy too much higher 37%
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versus 25% and they also saw more
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frequent use of um speech and swallow
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rehab and critically nutritional support
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services ah okay so it's not just about
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you know fixing the thing that needed
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surgery it's having that geriatric
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expert involved who maybe through their
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specialized assessment they're spotting
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the vulnerabilities that seems to be it
6:59
like the underlying frailty maybe
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nutritional gaps the risk of losing
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function things a busy surgeon might not
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be focused on quite as much precisely
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and that assessment that geriatric
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viewpoint seems to trigger getting the
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patient the specific tailored support
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they need support to rebuild their
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resilience basically to help them
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actually recover from that massive
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physiological hit that surgery
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represents so the geriatrician is kind
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of like the coordinator for recovery
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resilience you could put it that way
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they identify who needs that extra help
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regaining strength maybe preventing
7:31
falls making sure they're eating enough
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in the right things managing all their
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complex meds to maybe prevent delirium
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it seems like it's that proactive really
7:41
comprehensive support during the
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recovery journey that's making the
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life-saving difference helping patients
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just withstand the stress better and you
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know bounce back more successfully and
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this extra support it didn't just stop
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when they left the hospital did it i
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think the study mentioned discharge
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planning that's right yeah there was a
7:58
difference there too patients in the
8:00
management group were actually more
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likely to be discharged home
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specifically with home supportive
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services already set up ah so things
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like home health aids or maybe therapy
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continuing at home exactly which really
8:12
suggests a more um holistic and
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forwardthinking discharge plan was put
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in place making sure that scaffolding of
8:19
support those resources continued even
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after the patient got back to their own
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environment which as you can imagine is
8:25
crucial for keeping that recovery
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momentum going definitely okay now every
8:29
deep dive we have to look at the you
8:31
know the caveats the limitations this
8:34
was retrospective you said correct it
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was a retrospective cohort study which
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means they looked back at data that
8:40
already existed so not the gold standard
8:42
which is a randomized control trial
8:43
right in a randomized trial patients get
8:46
assigned purely by chance to one
8:48
treatment or the other here that didn't
8:50
happen patients weren't randomly
8:52
assigned the decision to uh refer
8:55
someone for geriatric management often
8:57
came down to the surgeon's clinical
8:59
judgment their preference and it was
9:01
done at just one place a big cancer
9:03
center but still just one place yes
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memorial
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Sloanketering which is you know a
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worldclass institution but results might
9:11
look a bit different in say a smaller
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community hospital setting that
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non-random assignment also means there's
9:17
a chance of um selection bias meaning
9:21
well maybe surgeons were more likely to
9:23
refer patients they already thought were
9:25
sicker or maybe the opposite they
9:26
referred patients they felt had the best
9:28
chance to benefit it's hard to know for
9:30
sure the statistical adjustments try to
9:32
account for some of that but it's not
9:34
perfect it's not perfect no it's still a
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limitation compared to that ideal
9:38
randomized design okay however even with
9:41
those points you have to look at the
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sheer size of this study nearly 1,900
9:45
patients and that really dramatic
9:48
statistically significant difference in
9:50
90-day mortality it's still extremely
9:53
compelling evidence it really is and the
9:55
authors themselves what was their main
9:57
takeaway their conclusion was pretty
9:59
clear these findings strongly suggest
10:01
that you know whenever it's feasible
10:03
older patients who are facing cancer
10:05
surgery should receive this kind of
10:07
geriatric care management and this
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really brings it home doesn't it the why
10:11
it matters for you part if you or you
10:13
know someone you love is looking at
10:15
surgery later in life mhm it's just
10:17
vital to recognize that older adults
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they really do have unique needs related
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to their body's reserves how they handle
10:25
stress their whole health picture which
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is often more complex and geriatricians
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are the specialists precisely trained to
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understand and manage all that
10:32
complexity so bringing that specific
10:35
expertise into the surgical care pathway
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well it isn't just a nice to have add-on
10:41
this study provides pretty powerful
10:43
evidence that it can actually be
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life-saving life-saving and
10:46
significantly improve the chances of a
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really robust meaningful recovery
10:51
afterwards it's just a fantastic example
10:54
I think of how collaborative care
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patient centered care care that's
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genuinely tailored to the specific needs
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of a group isn't just jargon it actually
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leads to tangible dramatic benefits real
11:07
improvements in patient outcomes and it
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really underscores that idea that
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innovation in medicine well it isn't
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always about a shiny new machine or the
11:14
latest drug not at all sometimes maybe
11:16
often it's about fundamentally
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rethinking how we organize care how we
11:20
deliver it making sure the right
11:22
expertise gets to the right patient at
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the right time absolutely well said and
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while the study is strong as we noted it
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also clearly points towards next steps
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for research like those randomized
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trials you mentioned exactly randomized
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control trials maybe in different types
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of hospitals would be great to confirm
11:38
these findings and maybe they could even
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help pinpoint exactly which parts of
11:43
that whole geriatric assessment and
11:44
support package are the most critical
11:46
for improving survival is it the
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nutrition the PT the medication
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management or the combination
11:55
fascinating stuff for the future so all
11:57
right wrapping up this deep dive the
11:59
core finding is pretty stunning it
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really is we've seen this compelling
12:02
evidence from Memorial Sloanketing that
12:05
integrating geriatric
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expertise bringing those aging
12:09
specialists onto the surgical team for
12:11
older cancer patients can dramatically
12:14
cut mortality within 90 days after
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surgery yeah essentially cutting that
12:18
adjusted risk in half in their large
12:20
study and it seems to work by
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understanding and proactively addressing
12:24
the unique vulnerabilities and needs of
12:26
older adults during that crucial
12:27
recovery period often through getting
12:29
them more tailored supportive care right
12:31
it highlights that this support isn't
12:33
just helpful it can be genuinely
12:34
life-saving and really change their
12:36
whole trajectory towards recovery so it
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leaves us and you listening with this
12:41
thought to mle over given this kind of
12:44
powerful evidence how do we work towards
12:46
making sure that this kind of tailored
12:48
expert care care that truly recognizes
12:51
the unique physiology and needs of older
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adults becomes the standard not just a
12:56
fortunate exception if you happen to be
12:58
at the right hospital or get the right
12:59
referral how do we advocate for a system
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where their specific needs aren't just
13:03
seen as you know general aging but as
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something requiring specialized
13:08
expertise for the very best possible
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outcome
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#Aging & Geriatrics
#Cancer
#Surgery