Nursing & Allied Health ECHO Case Presentations-Frailty in elderly patients

Video Transcription

Video Summary

Bruna, a nurse from A.C.Camargo Cancer Center in São Paulo, presents a challenging case about frailty and surgical decision-making in older adults. The patient is an 80-year-old woman with locally advanced uterine carcinosarcoma, significant vaginal bleeding for 30 days with anemia, poor nutrition, and major comorbidities including chronic kidney disease (creatinine 4.3). MRI showed extensive uterine disease with deep myometrial invasion and parametrial involvement.<br /><br />A multidisciplinary tumor board weighed surgery versus chemotherapy. Anesthesiology assessed high risk for postoperative dialysis and high chemotherapy toxicity; oncology contraindicated chemotherapy; nephrology did not contraindicate surgery. Geriatric assessment found no cognitive impairment and estimated non-cancer life expectancy of 5–7 years, noting high nutritional risk and functional vulnerability, but did not contraindicate surgery. The patient and family strongly requested surgery for symptom relief.<br /><br />Although planned as palliative surgery to control bleeding and pain, intraoperative findings led to more extensive surgery. Postoperatively, the patient suffered prolonged hospitalization (55 days) with delirium, infections, dialysis, C. difficile diarrhea, transfusion dependence, and ultimately died; palliative care and end-of-life protocols were initiated.<br /><br />The discussion centers on whether geriatric and anesthetic assessments are sufficient, the value of frailty indices (e.g., NSQIP) to quantify risk for patients/families, whether frailty tools should apply beyond the elderly, and the role of prehabilitation and nursing advocacy in optimizing outcomes.

Asset Subtitle

Recorded on March 13, 2026

Keywords

frailty assessment

geriatric oncology

surgical decision-making

uterine carcinosarcoma

palliative hysterectomy

multidisciplinary tumor board

chronic kidney disease

postoperative complications

prehabilitation