The impact of colorectal surgery on health-related quality of life in older functionally dependent patients with cancer - A longitudinal follow-up study.

BACKGROUND: Older patients who are functionally compromised or frail may be at risk for loss of quality of life (QoL) after colorectal cancer (CRC) surgery. We prospectively studied health-related QoL (HRQoL) and its association with functional dependency on multiple time points before and after CRC surgery. METHODS: Included were patients aged 70 years and older who underwent elective CRC surgery between 2014 and 2015 in combination with an oncogeriatric care path. HRQoL (EORTC QLQ-C30 and CR38) and activities of daily living (ADL, Barthel Index) were measured at four time-points; prior to (T0) and at 3 (T3), 6 (T6), and 12 (T12) months after surgery. Functional dependency was defined as a Barthel Index <19. Using mixed-model regression analysis associations between dependency, time and HRQoL outcomes were tested and corrected for confounders. RESULTS: Response rate was 67% (n = 106) to two or more questionnaires; 26 (25%) patients were functionally dependent. Overall, functionally independent patients experienced a higher HRQoL than dependent patients. Compared to T0, significant and clinically relevant improvements in HRQoL after surgery were observed in functionally dependent patients: better role functioning, a higher global health, a higher summary score, less fatigue and less gastrointestinal problems (p < .05). In functional independent patients, we observed no clinically relevant change in HRQoL. CONCLUSION: Colorectal surgery embedded in geriatric-oncological care has a positive impact on HRQoL in older functionally dependent patients with cancer. Moderate functional dependency should not be considered a generic reason for withholding surgical treatment. Information derived from this study could be used in shared decision making.

[Unexplained lymphadenopathy: Whipple disease]. / Onbegrepen lymfadenopathie: ziekte van Whipple.

A 58-year-old man was referred to the internal medicine outpatient department because of abdominal pain and lymphadenopathy. CT imaging revealed multiple mediastinal, para-aortic, mesenteric and pelvic lymphoma. Biopsy of an inguinal lymph node for histology purposes revealed granulomatous lymphadenitis. A watchful waiting approach was adopted. Two and a half years after first presentation, the patient presented with weight loss, fever and night sweats. CT imaging showed progressive lymphadenopathy and hepatosplenomegaly. Histopathological examination of a laparoscopically removed lymph node showed extensive infiltration with macrophages with stained rod-shaped bacteria (periodic acid-Schiff staining), which is typical of Whipple disease. PCR and biopsies of the small intestine confirmed the diagnosis. Antibiotic therapy was started with rapid clinical and biochemical improvement. A year later PCR of the duodenal biopsies was negative and the antibiotics were discontinued. Whipple disease is a rare chronic infection caused by Tropheryma whipplei. Clinical symptoms can vary, so it often takes a long time to diagnose.