Up next in 10
Deep Dive into a Collaboration that can Save Lives of Older Adults with Cancer after Surgery
0 views
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
View Video Transcript
0:04
you know when an older loved one has to
0:06
face major surgery especially with
0:09
cancer involved well it brings just a
0:11
huge amount of anxiety doesn't it oh
0:13
absolutely it's completely
0:14
understandable we all know surgery is
0:16
tough physically demanding but for
0:19
someone say 75 or older that worry about
0:21
how they'll recover but all the risks
0:23
involved it just feels
0:27
amplified significantly it really is
0:29
there's that very real concern about
0:31
their um their physiological reserve how
0:34
is their body actually going to cope
0:36
with the huge stress of an operation and
0:39
then bouncing back afterwards exactly
0:41
and often you're just so focused on the
0:44
surgery itself right just hope they get
0:45
through that part okay but what if um
0:49
what if a a key part of getting a better
0:52
outcome wasn't just the procedure but
0:54
really how you prepare for it and how
0:56
you support the whole recovery process
0:57
well that's getting right to it like
0:59
what if there was actually a way to
1:00
significantly cut the risk of the worst
1:02
outcomes and that's precisely what makes
1:04
the research we're uh digging into today
1:06
so compelling and actually really
1:08
hopeful we're looking at a study it was
1:10
published in JAMAN network open from
1:12
researchers over at Memorial Sloan
1:14
Kettering Cancer Center right mskcc so
1:17
let's unpack this source our mission for
1:20
this deep dive is basically to
1:22
understand what they found about this
1:24
specific approach they call it geriatric
1:27
commandment that's the term yeah and
1:29
figure out what it could actually mean
1:30
for older adults who are facing cancer
1:33
surgery maybe you know for you listening
1:35
or someone you care about so okay
1:37
geriatric management at its core um it's
1:40
about adding specialists in aging
1:42
geriatricians and making them a central
1:44
part of the surgical care team okay that
1:47
makes sense because well older adults
1:49
aren't just scaled up versions of
1:50
younger patients are they not at all
1:52
their bodies handle things differently
1:54
medications anesthesia they're often
1:57
more prone to things like confusion
1:59
afterwards
2:00
delirium bones might be more fragile
2:02
nutrition is a big factor all of that
2:05
and recovery from a huge stressor like a
2:07
major operation it just needs a
2:09
different kind of tailored support so
2:11
the geriatrician they're the expert
2:13
trained specifically to understand and
2:16
you know navigate all those complexities
2:18
they don't just see the cancer or the
2:20
operation in isolation they see the
2:22
whole person exactly the whole person
2:24
their thinking their nutrition how well
2:26
they move all the medications they might
2:28
be on their support system at home all
2:31
of it and it's a team thing you said
2:33
before and after yeah very much team-
2:36
based applied both before the surgery
2:38
trying to get the patient in the best
2:39
possible shape and then critically after
2:41
the surgery to really support that
2:43
recovery phase okay so the
2:45
million-dollar question for this study
2:46
then was does adding this specialized
2:50
sort of holistic expertise into the mix
2:52
actually change the outcome like life or
2:55
death outcomes for these older cancer
2:56
patients that was the core question to
2:58
find out the researchers did what's
3:00
called a retrospective cohort study so
3:02
they looked back at patient records okay
3:04
they examined data from uh nearly 1,900
3:07
patients all of them were 75 or older
3:10
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
3:18
effectively had two groups based on the
3:21
care they got one group the larger one
3:23
just over a,000 patients received this
3:26
geriatric management we're talking about
3:28
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
3:37
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
3:47
okay 3 months and this is where it gets
3:49
really interesting this is where it gets
3:51
frankly quite dramatic now they did
3:53
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
4:03
surgery the type and complexity of the
4:06
operation even how much blood was lost
4:08
they tried to level the playing field
4:10
statistically okay good so after
4:12
adjusting for all that what did they
4:13
find so for the group that got care only
4:16
from the surgical service the adjusted
4:18
probability of dying within those 90
4:20
days was 8.9% okay nearly 9% which
4:23
sounds high it reflects the risks for
4:26
this population undergoing major surgery
4:28
but then you look at the group that had
4:29
the geriatric management that number
4:31
dropped it plummeted really to just 4.3%
4:35
wow wait from 8.9 down to 4.3 that's
4:38
right a reduction of 4.6 percentage
4:40
points after adjustment it essentially
4:43
means they cut the risk of death within
4:44
90 days almost in half for the patients
4:47
who got that specialized geriatric
4:48
support that is that's huge that's a
4:50
massive difference it is they even
4:52
calculated something called the number
4:53
needed to treat what's that tell us it
4:55
was 22 which suggests based on this
4:58
study that for every 22 older cancer
5:01
patients who received this
5:02
commandagement approach one death within
5:04
that 90-day window might have been
5:06
prevented just think about that for
5:07
every 22 people one life potentially
5:11
saved in those crucial first months that
5:14
feels incredibly powerful for surgery in
5:16
this age group it really does and what's
5:18
especially fascinating is trying to
5:20
figure out how how did this approach
5:22
make such a big difference in survival
5:24
yeah what was the mechanism particularly
5:26
because the study found that the rates
5:28
of like immediate postsurgical problems
5:31
big complications trips back to the ER
5:34
getting readmitted to the hospital
5:36
within 30 days those rates were actually
5:39
pretty similar between the two groups
5:41
wait hold on so the geriatric team
5:43
wasn't necessarily stopping the
5:45
immediate surgical complication rate
5:47
from happening apparently not
5:49
significantly no but they were stopping
5:51
people from dying in the weeks and
5:53
months after how does that work that
5:56
seems a bit backwards well that's the
5:58
really key insight isn't it it seems to
5:59
point away from just the technical
6:01
success of the operation itself and more
6:03
towards the absolute critical importance
6:06
of the recovery process especially for
6:07
older adults okay and the study gave us
6:10
a big clue it highlighted what did
6:12
differ significantly between the groups
6:14
which was patients in that geriatric
6:16
management group they received
6:18
substantially more inpatient supportive
6:20
care services supportive care like what
6:24
kind of things things like physical
6:25
therapy uh 80% of the commanded group
6:29
got PT compared to only 63% in the
6:32
surgery only group big difference yeah
6:34
occupational therapy too much higher 37%
6:37
versus 25% and they also saw more
6:40
frequent use of um speech and swallow
6:43
rehab and critically nutritional support
6:45
services ah okay so it's not just about
6:49
you know fixing the thing that needed
6:50
surgery it's having that geriatric
6:53
expert involved who maybe through their
6:55
specialized assessment they're spotting
6:57
the vulnerabilities that seems to be it
6:59
like the underlying frailty maybe
7:01
nutritional gaps the risk of losing
7:03
function things a busy surgeon might not
7:06
be focused on quite as much precisely
7:08
and that assessment that geriatric
7:10
viewpoint seems to trigger getting the
7:12
patient the specific tailored support
7:14
they need support to rebuild their
7:16
resilience basically to help them
7:18
actually recover from that massive
7:19
physiological hit that surgery
7:21
represents so the geriatrician is kind
7:23
of like the coordinator for recovery
7:24
resilience you could put it that way
7:26
they identify who needs that extra help
7:29
regaining strength maybe preventing
7:31
falls making sure they're eating enough
7:33
in the right things managing all their
7:35
complex meds to maybe prevent delirium
7:39
it seems like it's that proactive really
7:41
comprehensive support during the
7:43
recovery journey that's making the
7:45
life-saving difference helping patients
7:47
just withstand the stress better and you
7:49
know bounce back more successfully and
7:51
this extra support it didn't just stop
7:54
when they left the hospital did it i
7:55
think the study mentioned discharge
7:57
planning that's right yeah there was a
7:58
difference there too patients in the
8:00
management group were actually more
8:02
likely to be discharged home
8:03
specifically with home supportive
8:05
services already set up ah so things
8:07
like home health aids or maybe therapy
8:10
continuing at home exactly which really
8:12
suggests a more um holistic and
8:15
forwardthinking discharge plan was put
8:17
in place making sure that scaffolding of
8:19
support those resources continued even
8:21
after the patient got back to their own
8:23
environment which as you can imagine is
8:25
crucial for keeping that recovery
8:26
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
8:36
was a retrospective cohort study which
8:38
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
9:05
memorial
9:06
Sloanketering which is you know a
9:08
worldclass institution but results might
9:11
look a bit different in say a smaller
9:13
community hospital setting that
9:15
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
9:36
limitation compared to that ideal
9:38
randomized design okay however even with
9:41
those points you have to look at the
9:42
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
10:09
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
10:20
they really do have unique needs related
10:23
to their body's reserves how they handle
10:25
stress their whole health picture which
10:27
is often more complex and geriatricians
10:29
are the specialists precisely trained to
10:31
understand and manage all that
10:32
complexity so bringing that specific
10:35
expertise into the surgical care pathway
10:38
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
10:44
life-saving life-saving and
10:46
significantly improve the chances of a
10:48
really robust meaningful recovery
10:51
afterwards it's just a fantastic example
10:54
I think of how collaborative care
10:57
patient centered care care that's
10:59
genuinely tailored to the specific needs
11:01
of a group isn't just jargon it actually
11:04
leads to tangible dramatic benefits real
11:07
improvements in patient outcomes and it
11:09
really underscores that idea that
11:11
innovation in medicine well it isn't
11:12
always about a shiny new machine or the
11:14
latest drug not at all sometimes maybe
11:16
often it's about fundamentally
11:18
rethinking how we organize care how we
11:20
deliver it making sure the right
11:22
expertise gets to the right patient at
11:23
the right time absolutely well said and
11:25
while the study is strong as we noted it
11:28
also clearly points towards next steps
11:30
for research like those randomized
11:32
trials you mentioned exactly randomized
11:34
control trials maybe in different types
11:36
of hospitals would be great to confirm
11:38
these findings and maybe they could even
11:40
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
11:49
nutrition the PT the medication
11:52
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
12:01
really is we've seen this compelling
12:02
evidence from Memorial Sloanketing that
12:05
integrating geriatric
12:07
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
12:16
surgery yeah essentially cutting that
12:18
adjusted risk in half in their large
12:20
study and it seems to work by
12:21
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
12:38
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
12:53
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
13:01
where their specific needs aren't just
13:03
seen as you know general aging but as
13:06
something requiring specialized
13:08
expertise for the very best possible
13:09
outcome
13:13
[Music]
13:25
[Music]
#Aging & Geriatrics
#Cancer
#Surgery