Authors:

Abstract

Aim: Of approximately 30,000 patients diagnosed with colorectal cancer between April 2014 and March 2015, 37% did not undergo major resection. In 11.8%, there was too much cancer and in 4.7% the patients were too frail with a large variation across trusts (0-32%). 2 year survival in those not undergoing major resection is only 30%. This study is designed to review the decision making process for those patients who are deemed to be too frail. How are patients being assessed for surgery? Is the decision process robust?

Patients: All patients diagnosed with colorectal cancer through their first discussed at the MDT would be identified and included.

Intervention: As a prospective multicentre observational study, there would be no intervention, however, patients will be divided into groups; those undergoing major resection (R) and those not undergoing major resection (NR), the second group being subdivided by reason; too much (TM) cancer, or too frail (TF).

Primary Outcomes: 1 & 2 year survival

Secondary outcomes: Mode of presentation (Emergency vs elective), Rockwood Frailty Score, anaesthetic assessment (performed or not, and type (i.e.CPEX)), review by geriatrician, patient decision, comorbidities, length of stay, Quality of life score , chemotherapy, colonic stenting, repeated blood transfusions, readmission with cancer complications.

All eligible patients identified at MDT will be included and have prospective data collected. Frailty scores, if not routinely used for MDT decision, will be collected posthoc and remain blind to the original MDT decision.