Post‐Acute Care among Older Adults with Stage I to III Colorectal Cancer

Abstract

BACKGROUND Little information is available on the long‐term use of post‐acute care among older patients with colorectal cancer (CRC), relative to individuals without cancer. This study examines the use of post‐acute care among older cancer survivors (>65 y) with CRC and compares it with noncancer patients up to 5 years from surgery. DESIGN Retrospective cohort. SETTING SEER‐Medicare. PARTICIPANTS Patients treated for stage I to III CRC between January 1, 2000, and December 31, 2011 (n = 40 812) and noncancer Medicare beneficiaries hospitalized for noncancer treatment matching on age, sex, race, comorbidity, and Medicaid dual eligibility. MEASUREMENTS Incident post‐acute care claims (skilled nursing, long‐term care facility, and home health) from 0 to 100 days, 101 to 365 days, and 1 to 5 years from hospitalization. RESULTS The median age was 77 years. All patients had surgery, 34% received chemotherapy, and 27% received surgery and adjuvant therapy. The cumulative incidence of any post‐acute care within 100 days of hospitalization was 45.7% for stage III, 37.9% for stage I/II, and 39% for controls (p < .001). Within the CRC cohort only, the cumulative incidence of post‐acute care was 2.9% (stage I/II) and 4.2% (stage III, p < .001) from 101 to 365 days and 15.8% (stage I/II) and 16.9% (stage III, p < .001) from 1 to 5 years. Increasing age, ostomies, and neoadjuvant or adjuvant therapy were associated with increased hazard of all post‐acute patients within 100 days from hospitalization. From 1 to 5 years from diagnosis, adjuvant therapy was associated with greater exclusive home health care use. CONCLUSIONS Survivorship planning among older CRC patients should include discussions of post‐acute care following cancer therapy, even several years after treatment. J Am Geriatr Soc 67:937–944, 2019.

Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study

“…[7][8][9] The long-term use of post-acute care services (eg, specialist nursing or long-term care facilities) is high among older adult cancer patients undergoing surgery when compared with those who have no cancer. 28 By 2 years postoperatively in the current study, approximately 1 in 5 patients was institutionalized, one-quarter had died, and one-half were living independently at home. A deterioration in living situation can be considered a proxy for functional status, 29 with an increased level of dependency in both activities of daily living and instrumental activities of daily living being precursors to institutionalization.…”

“…The long‐term use of post‐acute care services (eg, specialist nursing or long‐term care facilities) is high among older adult cancer patients undergoing surgery when compared with those who have no cancer . By 2 years postoperatively in the current study, approximately 1 in 5 patients was institutionalized, one‐quarter had died, and one‐half were living independently at home.…”

“…Other studies have reported that greater age, stage, impairment in pretreatment functional status, and treatment intensity, as well as the occurrence of postoperative complications, were associated with postoperative functional decline and increased long-term care use. 28,32,34,35 Functional decline can result from a protracted postoperative course in patients with reduced physiologic reserves at the start of their treatment, and studies showed that "prehabilitation" can have a positive effect on postoperative outcomes. [37][38][39] This indicates scope to improve PREOP risk scores and to reduce the risk of adverse outcomes.…”

Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 screening tool: a retrospective analysis using linked clinical and population-based data in Belgium

“…Some studies have assessed the use of home and residential care and conclude their use is higher in the older population with cancer than the general older population. 26,[38][39][40] Two of the studies also investigated care transitions in older patients with cancer but focused on home care or residential care alone. 39,40 The findings of these studies also underlined the importance of the first year after cancer diagnosis as a pivotal point in the care trajectory after cancer diagnosis.…”