Frailty, Quality Of Life and Early Reversal of Temporary Defunctioning Stoma in Ovarian Cancer

Official title

Frailty, Quality Of Life and Early Reversal of Temporary Defunctioning Stoma in Ovarian Cancer (FOLERO) : A Prospective Cohort Study to Determine the Effect of Frailty on Survival and to Assess Early Reversal of Temporary Intestinal Stoma

Overview

Complete macroscopic surgical resection (CMR) requires extensive surgery and combined with chemotherapy confers best chance of survival in advanced ovarian cancer. During cytoreductive surgery 11% of women require a temporary diverting intestinal stoma. Unexpectedly, our results from a unique fully accounted for population demonstrate that survival was not improved when increasing the proportion of women in whom CMR was achieved and in a yet unidentified subgroup of women extensive surgery was detrimental. In these women surgical treatment should be omitted in favor of chemotherapy only. Accordingly, there is an imperative need to improve patient selection to surgical treatment. In Sweden, we treat an unselected population of women in a public healthcare system, where 30% of women with are \>75 years. Despite these circumstances guidelines on patient-selection are lacking. Age is an imprecise variable to base clinical decisions on but must be considered with an aging population. The dynamics between physiological changes of aging, comorbidity and medical condition are included in the concept of frailty, that has gained little attention in oncology, despite their potential to stratify risk and mortality. The FOLERO study is a prospective adequately powered national cohort study with aim to determine if frailty instruments may be used to select patient to surgical treatment. In addition, we test the feasibility of early stoma reversal after index cytoreductive surgery in a small phase I trial and follow our patients Health Related Quality of Life after state of the art surgical treatment.

Detailed description

Hypothesis: Frailty is a predictor of poor survival Primary objective: To assess three different frailty instruments as predictors of survival Exposure: Frailty according to the three different frailty instruments evaluated Control: No frailty according to the three different frailty instruments evaluated Primary outcome measure: Overall survival

Secondary objectives (selection):

* To evaluate the effect of sarcopenia on postoperative outcome and survival * To evaluate the effect of surgical extent on postoperative outcome and survival * To describe the HRQoL and symptoms of the" Low anterior resection syndrome" after surgery

Phase I sub-study on the feasibility and safety of early stoma reversal (Karolinska University Hospital only)

Hypothesis: Early stoma reversal in select patients with advanced ovarian cancer is feasible and safe.

Primary objective: To assess the feasibility and safety of early closure of defunctioning stoma after upfront cytoreductive surgery in ovarian cancer Primary outcome measure : Feasibility and safety of early stoma reversal as measured by rate of anastomotic leakage, urgent re- operations and time-interval to adjuvant chemotherapy (defined cut-offs based on historic comparison in the study protocol)

Interventions

• Other Frailty and Quality of Life evaluation
  Frailty and Quality of Life evaluation after surgery

Primary outcome measures

• Overall Survival [Time frame: 24 months after index surgery]

Secondary outcome measures (12)

• 1-year mortality [Time frame: 12 months from index surgery]
• Health related quality of life (HRQoL) (QLQ-C30) [Time frame: At baseline, 12-15 weeks after index surgery and 12 months after index surgery]
• Health related quality of life (HRQoL) (QLQ-OV28) [Time frame: At baseline, 12-15 weeks after index surgery and 12 months after index surgery]
• Health related quality of life (HRQoL) (QLQ-ELD14) [Time frame: At baseline, 12-15 weeks after index surgery and 12 months after index surgery]
• Health related quality of life (HRQoL) (EQ-5D-5L) [Time frame: At baseline, 12-15 weeks after index surgery and 12 months after index surgery]
• Low anterior resection syndrome (LARS) [Time frame: At baseline, 12-15 weeks after index surgery and 12 months after index surgery]
• Postoperative complications [Time frame: 30 days after index surgery]
• Readmissions [Time frame: 30 days after index surgery]
• Length of hospital stay [Time frame: From date of index surgery to the date of discharge or at latest 90 days after index surgery]
• Extent of surgery vs survival [Time frame: Up to 60 months after index surgery]
• Sarcopenia vs post-operative outcome [Time frame: Up to 60 months after index surgery]
• Standard regimen of adjuvant chemotherapy [Time frame: At 1 year after index surgery]

Eligibility criteria

Inclusion criteria

• Women with epithelial ovarian cancer scheduled for cytoreductive surgery with curative intent
• Age ≥18 years
• Signed written informed consent

Exclusion criteria

• Not able to understand the Swedish or English language
• Other diagnosis than ovarian cancer on final pathology

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Other

Study locations

Sweden · 4 centers

• Karolinska University Hospital — Stockholm
• Sahlgrenska University Hospital and Sahlgrenska Academy — Gothenburg
• Linköping University Hospital — Linköping
• Skåne University Hospital — Lund

Publications

• Hunde D, Ekerstad N, Asp M, Kannisto P, Wedin M, Palmqvist C, Dahm-Kahler P, Brandberg Y, Abraham-Nordling M, Ahlund K, Morlin V, Groes-Kofoed N, Salehi S. Determining the effect of frailty on survival in advanced ovarian cancer: study protocol for a prospective multicentre national cohort study (FOLERO). Acta Oncol. 2025 Feb 5;64:208-213. doi: 10.2340/1651-226X.2025.42292. PMID 39907536

Identifiers

NCT: NCT06298877 · 2023-04696-01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗