xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06022666</url>
    </required_header>
    <id_info>
      <org_study_id>PATHTrial</org_study_id>
      <nct_id>NCT06022666</nct_id>
    </id_info>
    <brief_title>PATH Program for for Severely Frail or Cognitively Impaired Patients Scheduled for Cancer Surgery.</brief_title>
    <official_title>Application of the Palliative and Therapeutic Harmonization (PATH) Program for Shared-decision Making for Severely Frail or Cognitively Impaired Patients Scheduled for Cancer Surgery: a Randomized Control Trial.</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Nova Scotia Health Authority</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Nova Scotia Health Authority</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        This is a single center, non-blinded randomized control trial taking place at the Queen&#xD;
        Elizabeth II hospital (QEII) in Nova Scotia. Patients are eligible if aged 75 and older&#xD;
        scheduled for elective cancer surgery and screened as severely frail or cognitively impaired.&#xD;
        Participants will then be randomized to preoperative standard of care or geriatric assessment&#xD;
        through the PATH clinic. Primary outcome will assess time spend at home at 6 months after the&#xD;
        surgery.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        At Nova Scotia Health Authority (NSHA), geriatric medicine colleagues developed a&#xD;
        preoperative palliative and therapeutic harmonization (PATH) clinic with the following&#xD;
        objectives:&#xD;
  &#xD;
          1. Assess medical conditions, health trajectory, and baseline frailty.&#xD;
  &#xD;
          2. Conduct an in-depth discussion with the patient (or their substitute decision maker) to&#xD;
             review medical conditions and how frailty stage impacts decision-making about surgery.&#xD;
             3. Co-develop a care plan, including ways to optimize health.&#xD;
  &#xD;
        The investigators have elaborated a single center randomized cohort trial for patients aged&#xD;
        75 and older, screened as severely frail or cognitively impaired scheduled for curative or&#xD;
        palliative-intent surgery for bronchopulmonary, oropharyngeal, orthopaedic, gynaecological,&#xD;
        breast or gastrointestinal cancers.&#xD;
  &#xD;
        Patients enrolled in the trial will be randomized to standard of care preoperative assessment&#xD;
        versus PATH geriatric care arm.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">September 2023</start_date>
    <completion_date type="Anticipated">March 2026</completion_date>
    <primary_completion_date type="Anticipated">March 2026</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Other</primary_purpose>
      <masking>None (Open Label)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Time spent at home 6 months following cancer surgery.</measure>
      <time_frame>At 6 months postoperatively</time_frame>
      <description>Number of days spent at home vs in a hospital or care-facility unit dichotomized as low vs high time at home. High time at home defined as 14 or fewer institution days, and low time defined as more than 14 institution days at 6 months.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Preoperative factors associated with decreased proportion of time spent at home at 6 months.</measure>
      <time_frame>At 6 months postoperatively</time_frame>
    </primary_outcome>
    <secondary_outcome>
      <measure>Number of participants requiring home care utilization</measure>
      <time_frame>Assessed from date of hospital discharge (from index surgery) to 6 months postoperatively.</time_frame>
      <description>Receipt of any homeware service (nursing, wound care, social workers, physiotherapy) from the day of postoperative discharge from the hospital.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Number of participants experiencing death or development of persistent significant new disability.</measure>
      <time_frame>Assessed from date of index surgery to 6 months postoperatively.</time_frame>
      <description>Participant passing away or developing a new disability, from the day of index surgery. Assessed using the WHODAS 2.0 disability scale.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Preoperative factors associated with increased home care utilization, death, or new onset disability.</measure>
      <time_frame>Assessed up to 6 months postoperatively.</time_frame>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Rate of change to a non-operative strategy</measure>
      <time_frame>Assessed from date of randomization until documented confirmation that patient has opted for non surgical approach, assessed up to 6 months.</time_frame>
      <description>Rate of patients randomized to PATH clinic arm that end up declining surgery after consultation.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Decision regret scores.</measure>
      <time_frame>Assessed from date of hospital discharge (from index surgery) to 6 months postoperatively.</time_frame>
      <description>Decisional Regret Scale ranging from 0-100 scores measure the distress or remorse regarding the patient's decision made about undergoing surgery.</description>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">150</enrollment>
    <condition>Frailty</condition>
    <condition>Oncology Problem</condition>
    <condition>Cognitive Impairment</condition>
    <arm_group>
      <arm_group_label>Standard of care</arm_group_label>
      <arm_group_type>No Intervention</arm_group_type>
      <description>Patients will undergo the usual preoperative assessment from preoperative clinic which includes standard general internal medicine and anesthesia assessment.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>PATH geriatric care</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Pre-operative assessment through the PATH clinic</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Geriatric assessment</intervention_name>
      <description>Geriatric assessment through PATH clinic which includes an evaluation of comorbidities, health trajectory and baseline frailty as well as conducting an in-depth discussion with the patient on how frailty stage impacts decision-making about surgery in order to co-develop a care plan.</description>
      <arm_group_label>PATH geriatric care</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            1. Patients must have a pathologically confirmed diagnosis of bronchopulmonary,&#xD;
               oropharyngeal, orthopaedic, gynaecological, breast or gastrointestinal cancer surgery.&#xD;
  &#xD;
            2. Patients must be scheduled and consented for curative or palliative intent surgery.&#xD;
  &#xD;
            3. Patients must be aged 75 or older.&#xD;
  &#xD;
            4. Patients must be screened by the CFS to have:&#xD;
  &#xD;
          4a. Mild or greater frailty (CFS equal or greater than 5) due to cognitive impairment.&#xD;
  &#xD;
          4b. Moderate or greater frailty (CFS equal or greater than 6) due to medical/physical&#xD;
          conditions.&#xD;
  &#xD;
          5. Informed consent for participation must be received.&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            1. Patients cannot be a resident in a long-term care facility prior to the cancer&#xD;
               diagnosis.&#xD;
  &#xD;
            2. Urgent/ emergent cases are excluded.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>75 Years</minimum_age>
      <maximum_age>N/A</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Richard Spence, MD, FRCSC</last_name>
      <role>Principal Investigator</role>
      <affiliation>Queen Elizabeth II Health Sciences Center</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Richard Spence, MD, FRCSC</last_name>
      <phone>1 647 612 5904</phone>
      <email>Richard.Spence@dal.ca</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Elizabeth Tremblay, MD, FRCSC</last_name>
      <phone>514-826-4146</phone>
      <email>elizabeth.tremblay@umontreal.ca</email>
    </overall_contact_backup>
    <location>
      <facility>
        <name>QEII, Victoria General Hospital</name>
        <address>
          <city>Halifax</city>
          <state>Nova Scotia</state>
          <zip>B3H 2Y9</zip>
          <country>Canada</country>
        </address>
      </facility>
      <contact>
        <last_name>Richard Spence</last_name>
        <phone>647-612-5904</phone>
      </contact>
    </location>
    <location_countries>
      <country>Canada</country>
    </location_countries>
    <reference>
      <citation>Chesney TR, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Hsu AT, Wright F, Haas B, Hallet J; Recovery After Surgical Therapy for Older Adults Research-Cancer (RESTORE-Cancer) Group. All-Cause and Cancer-Specific Death of Older Adults Following Surgery for Cancer. JAMA Surg. 2021 Jul 1;156(7):e211425. doi: 10.1001/jamasurg.2021.1425. Epub 2021 Jul 14.</citation>
      <PMID>33978695</PMID>
    </reference>
    <reference>
      <citation>Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. 2001 Jul-Aug;4(4):172-7. Erratum In: Eff Clin Pract 2001 Sep-Oct;4(5):235.</citation>
      <PMID>11525104</PMID>
    </reference>
    <reference>
      <citation>McIsaac DI, Taljaard M, Bryson GL, Beaule PE, Gagne S, Hamilton G, Hladkowicz E, Huang A, Joanisse JA, Lavallee LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study. Ann Surg. 2020 Feb;271(2):283-289. doi: 10.1097/SLA.0000000000002967.</citation>
      <PMID>30048320</PMID>
    </reference>
    <reference>
      <citation>Zhang XM, Jiao J, Xie XH, Wu XJ. The Association Between Frailty and Delirium Among Hospitalized Patients: An Updated Meta-Analysis. J Am Med Dir Assoc. 2021 Mar;22(3):527-534. doi: 10.1016/j.jamda.2021.01.065. Epub 2021 Feb 5.</citation>
      <PMID>33549566</PMID>
    </reference>
    <reference>
      <citation>Spence RT, Hirpara DH, Doshi S, Quereshy FA, Chadi SA. ASO Author Reflections: A Reductionist's Approach to Risk-Adjusted Predictions and Outcomes Assessment: Less is More. Ann Surg Oncol. 2021 May;28(5):2788-2789. doi: 10.1245/s10434-020-09284-x. Epub 2020 Nov 5. No abstract available.</citation>
      <PMID>33151504</PMID>
    </reference>
    <reference>
      <citation>Spence RT, Hirpara DH, Doshi S, Quereshy FA, Chadi SA. Will My Patient Survive an Anastomotic Leak? Predicting Failure to Rescue Using the Modified Frailty Index. Ann Surg Oncol. 2021 May;28(5):2779-2787. doi: 10.1245/s10434-020-09221-y. Epub 2020 Oct 23.</citation>
      <PMID>33098049</PMID>
    </reference>
    <reference>
      <citation>Theou O, Perez-Zepeda MU, van der Valk AM, Searle SD, Howlett SE, Rockwood K. A classification tree to assist with routine scoring of the Clinical Frailty Scale. Age Ageing. 2021 Jun 28;50(4):1406-1411. doi: 10.1093/ageing/afab006.</citation>
      <PMID>33605412</PMID>
    </reference>
    <reference>
      <citation>Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL, Purviance G, Bockman T, Lynch TG, Johanning JM. Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days. JAMA Surg. 2017 Mar 1;152(3):233-240. doi: 10.1001/jamasurg.2016.4219.</citation>
      <PMID>27902826</PMID>
    </reference>
    <reference>
      <citation>Chesney TR, Haas B, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Wright F, Hsu AT, Hallet J. Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study. Eur J Surg Oncol. 2021 Apr;47(4):888-895. doi: 10.1016/j.ejso.2020.09.009. Epub 2020 Sep 16.</citation>
      <PMID>32980211</PMID>
    </reference>
    <reference>
      <citation>Moorhouse P, Mallery LH. Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults. J Am Geriatr Soc. 2012 Dec;60(12):2326-32. doi: 10.1111/j.1532-5415.2012.04210.x. Epub 2012 Oct 30.</citation>
      <PMID>23110462</PMID>
    </reference>
    <reference>
      <citation>Chesney TR, Haas B, Coburn NG, Mahar AL, Zuk V, Zhao H, Wright FC, Hsu AT, Hallet J; Recovery After Surgical Therapy for Older Adults Research-Cancer (RESTORE-Cancer) Group. Patient-Centered Time-at-Home Outcomes in Older Adults After Surgical Cancer Treatment. JAMA Surg. 2020 Nov 1;155(11):e203754. doi: 10.1001/jamasurg.2020.3754. Epub 2020 Nov 18.</citation>
      <PMID>33026417</PMID>
    </reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>April 13, 2023</study_first_submitted>
    <study_first_submitted_qc>August 31, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">September 5, 2023</study_first_posted>
    <last_update_submitted>August 31, 2023</last_update_submitted>
    <last_update_submitted_qc>August 31, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 5, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Nova Scotia Health Authority</investigator_affiliation>
      <investigator_full_name>Richard Spence</investigator_full_name>
      <investigator_title>Principal Investigator, Surgical Oncologist, Associate Beatrice Hunter Cancer Institute</investigator_title>
    </responsible_party>
    <keyword>frailty</keyword>
    <keyword>cognitive impairment</keyword>
    <keyword>cancer surgery</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Frailty</mesh_term>
      <mesh_term>Cognitive Dysfunction</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06022666
  org study id: PATHTrial
  nct id: NCT06022666
  lead sponsor: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  This is a single center, non-blinded randomized control trial taking place at the Queen
        Elizabeth II hospital (QEII) in Nova Scotia. Patients are eligible if aged 75 and older
        scheduled for elective cancer surgery and screened as severely frail or cognitively impaired.
        Participants will then be randomized to preoperative standard of care or geriatric assessment
        through the PATH clinic. Primary outcome will assess time spend at home at 6 months after the
        surgery.
  At Nova Scotia Health Authority (NSHA), geriatric medicine colleagues developed a
        preoperative palliative and therapeutic harmonization (PATH) clinic with the following
        objectives:
  
          1. Assess medical conditions, health trajectory, and baseline frailty.
  
          2. Conduct an in-depth discussion with the patient (or their substitute decision maker) to
             review medical conditions and how frailty stage impacts decision-making about surgery.
             3. Co-develop a care plan, including ways to optimize health.
  
        The investigators have elaborated a single center randomized cohort trial for patients aged
        75 and older, screened as severely frail or cognitively impaired scheduled for curative or
        palliative-intent surgery for bronchopulmonary, oropharyngeal, orthopaedic, gynaecological,
        breast or gastrointestinal cancers.
  
        Patients enrolled in the trial will be randomized to standard of care preoperative assessment
        versus PATH geriatric care arm.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Other
  masking: None (Open Label)
  measure: Time spent at home 6 months following cancer surgery.
  time frame: At 6 months postoperatively
  description: Number of days spent at home vs in a hospital or care-facility unit dichotomized as low vs high time at home. High time at home defined as 14 or fewer institution days, and low time defined as more than 14 institution days at 6 months.
  measure: Preoperative factors associated with decreased proportion of time spent at home at 6 months.
  time frame: At 6 months postoperatively
  measure: Number of participants requiring home care utilization
  time frame: Assessed from date of hospital discharge (from index surgery) to 6 months postoperatively.
  description: Receipt of any homeware service (nursing, wound care, social workers, physiotherapy) from the day of postoperative discharge from the hospital.
  measure: Number of participants experiencing death or development of persistent significant new disability.
  time frame: Assessed from date of index surgery to 6 months postoperatively.
  description: Participant passing away or developing a new disability, from the day of index surgery. Assessed using the WHODAS 2.0 disability scale.
  measure: Preoperative factors associated with increased home care utilization, death, or new onset disability.
  time frame: Assessed up to 6 months postoperatively.
  measure: Rate of change to a non-operative strategy
  time frame: Assessed from date of randomization until documented confirmation that patient has opted for non surgical approach, assessed up to 6 months.
  description: Rate of patients randomized to PATH clinic arm that end up declining surgery after consultation.
  measure: Decision regret scores.
  time frame: Assessed from date of hospital discharge (from index surgery) to 6 months postoperatively.
  description: Decisional Regret Scale ranging from 0-100 scores measure the distress or remorse regarding the patient's decision made about undergoing surgery.
  arm group label: Standard of care
  arm group type: No Intervention
  description: Patients will undergo the usual preoperative assessment from preoperative clinic which includes standard general internal medicine and anesthesia assessment.
  arm group label: PATH geriatric care
  arm group type: Experimental
  description: Pre-operative assessment through the PATH clinic
  intervention type: Other
  intervention name: Geriatric assessment
  description: Geriatric assessment through PATH clinic which includes an evaluation of comorbidities, health trajectory and baseline frailty as well as conducting an in-depth discussion with the patient on how frailty stage impacts decision-making about surgery in order to co-develop a care plan.
  arm group label: PATH geriatric care
  criteria: 
  gender: All
  minimum age: 75 Years
  maximum age: N/A
  healthy volunteers: No
  last name: Richard Spence, MD, FRCSC
  role: Principal Investigator
  affiliation: Queen Elizabeth II Health Sciences Center
  last name: Richard Spence, MD, FRCSC
  phone: 1 647 612 5904
  email: Richard.Spence@dal.ca
  last name: Elizabeth Tremblay, MD, FRCSC
  phone: 514-826-4146
  email: elizabeth.tremblay@umontreal.ca
  facility: 
  contact: 
  country: Canada
  citation: Chesney TR, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Hsu AT, Wright F, Haas B, Hallet J; Recovery After Surgical Therapy for Older Adults Research-Cancer (RESTORE-Cancer) Group. All-Cause and Cancer-Specific Death of Older Adults Following Surgery for Cancer. JAMA Surg. 2021 Jul 1;156(7):e211425. doi: 10.1001/jamasurg.2021.1425. Epub 2021 Jul 14.
  PMID: 33978695
  citation: Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. 2001 Jul-Aug;4(4):172-7. Erratum In: Eff Clin Pract 2001 Sep-Oct;4(5):235.
  PMID: 11525104
  citation: McIsaac DI, Taljaard M, Bryson GL, Beaule PE, Gagne S, Hamilton G, Hladkowicz E, Huang A, Joanisse JA, Lavallee LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study. Ann Surg. 2020 Feb;271(2):283-289. doi: 10.1097/SLA.0000000000002967.
  PMID: 30048320
  citation: Zhang XM, Jiao J, Xie XH, Wu XJ. The Association Between Frailty and Delirium Among Hospitalized Patients: An Updated Meta-Analysis. J Am Med Dir Assoc. 2021 Mar;22(3):527-534. doi: 10.1016/j.jamda.2021.01.065. Epub 2021 Feb 5.
  PMID: 33549566
  citation: Spence RT, Hirpara DH, Doshi S, Quereshy FA, Chadi SA. ASO Author Reflections: A Reductionist's Approach to Risk-Adjusted Predictions and Outcomes Assessment: Less is More. Ann Surg Oncol. 2021 May;28(5):2788-2789. doi: 10.1245/s10434-020-09284-x. Epub 2020 Nov 5. No abstract available.
  PMID: 33151504
  citation: Spence RT, Hirpara DH, Doshi S, Quereshy FA, Chadi SA. Will My Patient Survive an Anastomotic Leak? Predicting Failure to Rescue Using the Modified Frailty Index. Ann Surg Oncol. 2021 May;28(5):2779-2787. doi: 10.1245/s10434-020-09221-y. Epub 2020 Oct 23.
  PMID: 33098049
  citation: Theou O, Perez-Zepeda MU, van der Valk AM, Searle SD, Howlett SE, Rockwood K. A classification tree to assist with routine scoring of the Clinical Frailty Scale. Age Ageing. 2021 Jun 28;50(4):1406-1411. doi: 10.1093/ageing/afab006.
  PMID: 33605412
  citation: Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL, Purviance G, Bockman T, Lynch TG, Johanning JM. Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days. JAMA Surg. 2017 Mar 1;152(3):233-240. doi: 10.1001/jamasurg.2016.4219.
  PMID: 27902826
  citation: Chesney TR, Haas B, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Wright F, Hsu AT, Hallet J. Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study. Eur J Surg Oncol. 2021 Apr;47(4):888-895. doi: 10.1016/j.ejso.2020.09.009. Epub 2020 Sep 16.
  PMID: 32980211
  citation: Moorhouse P, Mallery LH. Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults. J Am Geriatr Soc. 2012 Dec;60(12):2326-32. doi: 10.1111/j.1532-5415.2012.04210.x. Epub 2012 Oct 30.
  PMID: 23110462
  citation: Chesney TR, Haas B, Coburn NG, Mahar AL, Zuk V, Zhao H, Wright FC, Hsu AT, Hallet J; Recovery After Surgical Therapy for Older Adults Research-Cancer (RESTORE-Cancer) Group. Patient-Centered Time-at-Home Outcomes in Older Adults After Surgical Cancer Treatment. JAMA Surg. 2020 Nov 1;155(11):e203754. doi: 10.1001/jamasurg.2020.3754. Epub 2020 Nov 18.
  PMID: 33026417
  responsible party type: Principal Investigator
  investigator affiliation: Nova Scotia Health Authority
  investigator full name: Richard Spence
  investigator title: Principal Investigator, Surgical Oncologist, Associate Beatrice Hunter Cancer Institute
  mesh term: Frailty
  mesh term: Cognitive Dysfunction
  sharing ipd: No