Predictors of Preoperative Quality of Life in Older Patients With Colorectal Cancer in Taiwan: A Retrospective Cohort Study.

BackgroundColorectal cancer (CRC) predominantly affects older adults, whose treatment outcomes may be influenced by baseline health-related quality of life (HRQoL). This study aimed to identify predictors of poor preoperative HRQoL in older patients undergoing CRC surgery and to stratify them into risk groups.MethodsWe retrospectively analyzed data on patients aged ≥65 years who underwent radical CRC surgery at a single medical center in Taiwan (2016-2018). Preoperative HRQoL was assessed using the EORTC QLQ-ELD14 questionnaire and a comprehensive geriatric assessment. Patients were stratified into high or low HRQoL groups based on the median QLQ-ELD14 sum score. Logistic regression identified independent predictors of poor HRQoL, and recursive partitioning analysis (RPA) was applied for risk stratification.ResultsAmong the 179 patients, the most distressing HRQoL domains were Burden of Disease, Maintaining Purpose, and Worries about Others. Independent predictors of poor HRQoL included female sex (adjusted odds ratio [OR] = 2.41, P = 0.029), frailty (adjusted OR = 1.53, P = 0.042), poor Eastern Cooperative Oncology Group (ECOG) performance status (adjusted OR = 2.19, P = 0.008), and lower educational attainment (adjusted OR = 0.23, P = 0.019). RPA identified five patient subgroups with distinct risk levels; frail female had the highest risk (71.4%), while fit patients with college education or higher had the lowest (9.5%).ConclusionFrailty, functional status, sex, and education level are key determinants of preoperative HRQoL in older patients with CRC. The RPA provides a simple tool to identify high-risk patients, allowing targeted preoperative interventions to optimize care and enhance surgical outcomes.