Comprehensive Geriatric Assessment–Based Multidisciplinary Decision-Making in Octogenarians with Colorectal Cancer

<title>Abstract</title> <p>Methods We conducted a prospective observational study including patients aged ≥ 80 years with colorectal cancer (CRC) initially considered candidates for curative surgery at a tertiary hospital between 2018 and 2022. All patients underwent CGA performed by the same experienced geriatrician, supported by a specialised geriatric nurse. Based on multidimensional assessment, patients were classified into four CGA-based geriatric groups: fit (Type 1), pre-frail (Type 2), frail (Type 3), and dependent or poor prognosis (Type 4). Final treatment recommendations were established by a multidisciplinary tumour board. The primary outcome was the association between CGA-based geriatric classification and final multidisciplinary treatment recommendation. Results A total of 184 patients (mean age 84.1 ± 4.3 years) were included. Following CGA, 45.1% were Type 1, 29.5% Type 2, 19.6% Type 3, and 6.0% Type 4. Treatment recommendations differed markedly across CGA-based geriatric groups (p &lt; 0.001). The proportion undergoing surgery decreased from 93.2% in Type 1 patients to 18.2% in Type 4 patients, whereas palliative treatment increased progressively. Treatment refusal occurred in 11% and was most frequent among patients classified as Type 3. In multivariable analysis, CGA-based classification remained independently associated with treatment recommendation after adjustment for age, sex and comorbidity. Conclusions In octogenarians with CRC considered for curative surgery, CGA-based geriatric classification was strongly associated with final multidisciplinary treatment recommendations. Beyond risk stratification, CGA provides clinical information that may facilitate personalized treatment selection and shared decision-making.</p>