“Having surgery is necessary” – a qualitative analysis of the experiences of frail older adults treated with, and recovering from colorectal cancer surgery

Frail older adults undergoing surgical treatment for colorectal cancer are at increased risk of postoperative mortality and complications compared with non-frail older adults. Even though these risks are established, limited research has explored patient perspectives on surgical treatment and recovery in frail older adults. This study aimed to explore the experiences of frail older adults during diagnosis, treatment, and recovery from surgically treated colorectal cancer. Participants were recruited through purposive sampling from the control group of the randomized controlled trial “Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer – the Colorectal Cancer Frailty Study.” Patients in the control group receive standardised treatment according to best practice within an ERAS-concept. Sixteen semi-structured interviews were conducted 6–22 months post-surgery. All interviews were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis with a focus on both manifest and latent content. Participants perceived surgery as essential for survival. They expressed considerable trust in health care professionals and showed limited interest in being actively involved in medical decision-making. Even among those who experienced postoperative challenges—such as reduced physical function and increased dependence on others—there was a high level of acceptance and a prevailing sense that the treatment had been worthwhile. Overall, the experience of the treatment was described in a positive sense, and participants stated that they would choose to undergo the procedure again if necessary. The findings of this study revealed that participants sought clear and concrete recommendations and expressed limited interest in influencing medical decision-making. There was a strong will to undergo surgery despite complicating factors such as advanced age, frailty, and comorbidities. A general acceptance of age-related functional decline may have contributed to the sense of being content with treatment outcomes, even in the presence of postoperative challenges. The findings reflect the perspective of surgically treated, mild to moderately frail older adults with colorectal cancer, who survived at least six months after surgery, and the results should be interpreted within this context. OSF registry: https://osf.io/c94xb/, registered May 24, 2025.