Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2021

01-03-2021 | Care | Health Services Research and Global Oncology

Immediate and Long-Term Health Care Support Needs of Older Adults Undergoing Cancer Surgery: A Population-Based Analysis of Postoperative Homecare Utilization

Authors: Tyler R. Chesney, MD, MSc, Barbara Haas, MD, PhD, Natalie G. Coburn, MD, MPH, Alyson L. Mahar, PhD, Victoria Zuk, MHSc, Haoyu Zhao, MPH, Amy T. Hsu, PhD, Julie Hallet, MD, MSc, Recovery after Surgical Therapy for Older Adults Research–Cancer (RESTORE-Cancer) Group

Published in: Annals of Surgical Oncology | Issue 3/2021

Login to get access

Abstract

Background

Functional outcomes are central to decision-making by older adults (OA), but long-term risks after cancer surgery have not been described beyond 1 year for this population. This study aimed to evaluate long-term health care support needs by examining homecare use after cancer surgery for OA.

Methods

This population-based study investigated adults 70 years of age or older with a new cancer diagnosis between 2007 and 2017 who underwent resection. The outcomes were receipt and intensity of homecare from postoperative discharge to 5 years after surgery. Time-to-event analysis with competing events was used.

Results

Among 82,037 patients, homecare use was highest (43.7% of eligible patients) in postoperative month 1. The need for homecare subsequently decreased to stabilize between year 1 (13.9%) and year 5 (12.6%). Of the patients not receiving preoperative homecare, 10.9% became long-term users at year 5 after surgery. Advancing age, female sex, frailty, high-intensity surgery, more recent period of surgery, and receipt of preoperative homecare were associated with increased hazards of postoperative homecare. Intensity of homecare went from 10.3 to 10.1 days per patient-month between month 1 and year 1, reaching 12 days per patient-month at year 5. The type of homecare services changed from predominantly nursing care in year 1 (51.9%) to increasing personal support services from year 2 (69.6%) to year 5 (77.5%).

Conclusion

Receipt of homecare increased long-term after cancer surgery for OA, peaking in the first 6 months and plateauing thereafter at a new baseline. One tenth of the patients without preoperative homecare became long-term homecare users postoperatively, indicating changing health care needs focused on personal support services from year 2 to year 5.
Appendix
Available only for authorised users
Literature
1.
Edwards BK, Howe HL, Ries LAG, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94:2766–92.
2.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–65.PubMed
3.
Vercelli M, Quaglia A, Casella C, Parodi S, Capocaccia R, Martinez Garcia C. Relative survival in elderly cancer patients in Europe. EUROCARE Working Group. Eur J Cancer. 1998;34(14):2264–70.
4.
Nabozny MJ, Kruser JM, Steffens NM, Brasel KJ, Campbell TC, Gaines ME, et al. Constructing high-stakes surgical decisions: it’s better to die trying. Ann Surg. 2016;263:64–70.PubMedPubMedCentral
5.
Fried TR, Van Ness PH, Byers AL, Towle VR, O’Leary JR, Dubin JA. Changes in preferences for life-sustaining treatment among older persons with advanced illness. 2nd ed. J Gen Intern Med. 2007;22:495–501.
6.
Barnato AE, Herndon MB, Anthony DL, Gallagher PM, Skinner JS, Bynum JPW, et al. Are regional variations in end-of-life care intensity explained by patient preferences? A study of the US Medicare population. Med Care. 2007;45:386–93.PubMedPubMedCentral
7.
Tinetti ME, Naik AD, Dodson JA. Moving from disease-centered to patient goals-directed care for patients with multiple chronic conditions: patient value-based care. JAMA Cardiol. 2016;1:9–10.PubMedPubMedCentral
8.
Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons, NSQIP, and the American Geriatrics Society. JACS. Am Coll Surg. 2016;222:930–47.
9.
Al-Refaie WB, Parsons HM, Henderson WG, Jensen EH, Tuttle TM, Vickers SM, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010;251:311–8.PubMed
10.
Fujii S, Tsukamoto M, Fukushima Y, Shimada R, Okamoto K, Tsuchiya T, et al. Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients. World J Gastrointest Oncol. 2016;8:573–82.PubMedPubMedCentral
11.
Markar SR, Karthikesalingam A, Thrumurthy S, Ho A, Muallem G, Low DE. Systematic review and pooled analysis assessing the association between elderly age and outcome following surgical resection of esophageal malignancy. Dis Esophagus. 2013;26:250–62.PubMed
12.
Wang J-F, Zhang S-Z, Zhang N-Y, Wu Z-Y, Feng J-Y, Ying L-P, et al. Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis. World J Surg Oncol. 2016;14:90.PubMedPubMedCentral
13.
Pędziwiatr M, Małczak P, Mizera M, Witowski J, Torbicz G, Major P, et al. Pancreatoduodenectomy for pancreatic head tumors in the elderly: systematic review and meta-analysis. Surg Oncol. 2018;27:346–64.PubMed
14.
Wang H-H, Zhang C-Z, Zhang B-L, Chen J, Zeng X-L, Deng L, et al. Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with stage I non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2017;8:6033–42.PubMed
15.
Fonteyne V, Ost P, Bellmunt J, Droz JP, Mongiat-Artus P, Inman B, et al. Curative treatment for muscle invasive bladder cancer in elderly patients: a systematic review. Eur Urol. 2018;73:40–50.PubMed
16.
Bourgin C, Saidani M, Poupon C, Cauchois A, Foucher F, Leveque J, et al. Endometrial cancer in elderly women: which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol. 2016;42:166–75.PubMed
17.
Aspell N, O’Sullivan M, O’Shea E, Irving K, Duffy C, Gorman R, et al. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry. 2019;32:1466–1007.
18.
Jarling A, Rydström I, Ernsth-Bravell M, Nyström M, Dalheim-Englund A-C. Becoming a guest in your own home: home care in Sweden from the perspective of older people with multimorbidities. Int J Older People Nurs. 2018;13:e12194.PubMed
19.
Lavallee DC, Chenok KE, Love RM, Petersen C, Holve E, Segal CD, et al. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff Millwood. 2016;35:575–82.PubMed
20.
Porter ME. What is value in health care? N Engl J Med. 2010;363:2477–81.PubMed
21.
Lynn J, McKethan A, Jha AK. Value-based payments require valuing what matters to patients. JAMA. 2015;314:1445–6.PubMed
22.
23.
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med Public Library Sci. 2015;12:e1001885–22.
24.
Robles SC, Marrett LD, Clarke EA, Risch HA. An application of capture-recapture methods to the estimation of completeness of cancer registration. J Clin Epidemiol. 1988;41:495–501.PubMed
25.
Iron K, Zagorski BM, Sykora K, Manuel DG. Living and Dying in Ontario: An Opportunity for Improved Health Information: Investigative Report. Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada, 2008.
26.
Karlj B. Measuring “rurality” for purposes of health-care planning: an empirical measure for Ontario. Ont Med Rev. 2009:33–52.
27.
Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999;341:1359–67.PubMed
28.
Wilkins R. Use of postal codes and addresses in the analysis of health data. Health Rep. 1993;5:157–77.PubMed
29.
Turner G, Clegg A, British Geriatrics Society, Age UK, Royal College of General Practioners. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Vol. 43, Age and ageing. 2014. pp. 744–7.
30.
Sternberg SA, Wershof Schwartz A, Karunananthan S, Bergman H, Mark Clarfield A. The identification of frailty: a systematic literature review. J Am Geriatr Soc. 2011;59:2129–38.PubMed
31.
Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991;29:452–72.PubMed
32.
Reid RJ, MacWilliam L, Verhulst L, Roos N, Atkinson M. Performance of the ACG case-mix system in two Canadian provinces. Med Care. 2001;39:86–99.PubMed
33.
Neuman HB, Weiss JM, Leverson G, O’Connor ES, Greenblatt DY, Loconte NK, et al. Predictors of short-term postoperative survival after elective colectomy in colon cancer patients ≥ 80 years of age. Ann Surg Oncol. 2013;20:1427–35.PubMedPubMedCentral
34.
McIsaac DI, Bryson GL, van Walraven C. Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: a population-based cohort study. JAMA Surg. 2016;151:538–45.PubMed
35.
Schwarze ML, Barnato AE, Rathouz PJ, Zhao Q, Neuman HB, Winslow ER, et al. Development of a list of high-risk operations for patients 65 years and older. JAMA Surg. 2015;150:325–31.PubMedPubMedCentral
36.
Fisch MJ, Zhao F, Manola J, Miller AH, Pirl WF, Wagner LI. Patterns and predictors of antidepressant use in ambulatory cancer patients with common solid tumors. Psychooncology. 2015;24:523–32.PubMed
37.
Gardner W, Mulvey EP, Shaw EC. Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychol Bull. 1995;118:392–404.PubMed
38.
McIsaac DI, Wijeysundera DN, Huang A, Bryson GL, van Walraven C. Association of the hospital volume of frail surgical patients cared for with outcomes after elective, major noncardiac surgery: a retrospective population-based cohort study. Anesthesiology. 2017;126:602–13.PubMed
39.
Andersson M, Hallberg IR, Edberg A-K. Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life: a qualitative study. Int J Nurs Stud. 2008;45:818–28.PubMed
40.
Abreu W, Tolson D, Jackson GA, Staines H, Costa N. The relationship between frailty, functional dependence, and healthcare needs among community-dwelling people with moderate to severe dementia. Health Soc Care Community. 2019;27:642–53.PubMed
41.
Griffith LE, Gruneir A, Fisher K, Panjwani D, Gandhi S, Sheng L, et al. Patterns of health service use in community living older adults with dementia and comorbid conditions: a population-based retrospective cohort study in Ontario, Canada. BMC Geriatr BioMed Central. 2016;16:177.
42.
Hing E, Bloom B. Vital and health statistics: long-term care for the functionally dependent elderly. National Centre Health Stat Vital Health Stat US Department Health Human Serv. 1990;13(104):1–57.
43.
Byrne K, Frazee K, Sims-Gould J, Martin-Matthews A. Valuing the older person in the context of delivery and receipt of home support. J Appl Gerontol. 2011;31:377–401.
44.
Ayalon L. Fears come true: the experiences of older care recipients and their family members of live-in foreign home care workers. Int Psychogeriatr. 2009;21:779–86.PubMed
45.
Devon KMD, Urbach DRU, McLeod RSM. Postoperative disposition and health services use in elderly patients undergoing colorectal cancer surgery: a population-based study. Surgery. 2011;149:705–12.PubMed
46.
Bowles KH, McCorkle R, Nuamah IF. Homecare referrals and 12-week outcomes following surgery for cancer. Oncol Nurs Forum. 2008;35:377–83.PubMedPubMedCentral
47.
Scotté F, Bossi P, Carola E, Cudennec T, Dielenseger P, Gomes F, et al. Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide. Ann Oncol. 2018;29:1718–26.PubMed
48.
Mohanty S, Rosenthal RA, Russell M, Neuman M, Ko CY, Esnaola NF. Optimal perioperative management of the geriatric patient: best practices guideline from ACS NSQIP. Am Geriatrics Soc. 2015:1–65.
49.
Hurria A, Mohile SG, Dale W. Research priorities in geriatric oncology: addressing the needs of an aging population. J Natl Compr Canc Netw. 2012;10:286–8.PubMedPubMedCentral
50.
Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and perioperative outcomes: a narrative review. Can J Anaesth. 2015;62:143–57.PubMed
51.
Alter DA, Franklin B, Ko DT, Austin PC, Lee DS, Oh PI, et al. Socioeconomic status, functional recovery, and long-term mortality among patients surviving acute myocardial infarction. PLoS ONE. 2014;8:e65130.PubMed
52.
Booth CM, Li G, Zhang-Salomons J, Mackillop WJ. The impact of socioeconomic status on stage of cancer at diagnosis and survival: a population-based study in Ontario, Canada. Cancer. 2010;116:4160–7.PubMed
53.
Danforth RM, Pitt HA, Flanagan ME, Brewster BD, Brand EW, Frankel RM. Surgical inpatient satisfaction: what are the real drivers? Surgery. 2014;156:328–35.PubMed
54.
Soroceanu A, Ching A, Abdu W, McGuire K. Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine. 2012;37:E103–8.PubMed
55.
Morasso G, Capelli M, Viterbori P, Di Leo S, Alberisio A, Costantini M, et al. Psychological and symptom distress in terminal cancer patients with met and unmet needs. J Pain Symptom Manage. 1999;17:402–9.PubMed
56.
Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly. a randomized clinical trial. Ann Int Med. 1994;120:999–1006.
57.
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613–20.PubMed
Metadata
Title
Immediate and Long-Term Health Care Support Needs of Older Adults Undergoing Cancer Surgery: A Population-Based Analysis of Postoperative Homecare Utilization
Authors
Tyler R. Chesney, MD, MSc
Barbara Haas, MD, PhD
Natalie G. Coburn, MD, MPH
Alyson L. Mahar, PhD
Victoria Zuk, MHSc
Haoyu Zhao, MPH
Amy T. Hsu, PhD
Julie Hallet, MD, MSc
Recovery after Surgical Therapy for Older Adults Research–Cancer (RESTORE-Cancer) Group
Publication date
01-03-2021
Publisher
Springer International Publishing
Keyword
Care
Published in
Annals of Surgical Oncology / Issue 3/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08992-8

Other articles of this Issue 3/2021

Annals of Surgical Oncology 3/2021 Go to the issue

ASO Author Reflections

ASO Author Reflections: The Impact of Preoperative Chemotherapy on Survival After Esophagectomy in Elderly Patients with Esophageal Cancer

Peritoneal Surface Malignancy

Novel Application of Iterative Hyperthermic Intraperitoneal Chemotherapy for Unresectable Peritoneal Metastases from High-Grade Appendiceal Ex-Goblet Adenocarcinoma

Health Services Research and Global Oncology

Where the Other Half Dies: Analysis of Mortalities Occurring More Than 30 Days After Complex Cancer Surgery

ASO Author Reflections

ASO Author Reflections: Ultrasound Assessment of the Lymphatic Drainage Area in Melanoma Patients With In-Transit Metastases

Breast Oncology

Predictors of Reexcision following Breast-Conserving Surgery for Ductal Carcinoma In Situ

Colorectal Cancer

Impact of Postoperative Complications on Oncologic Outcomes After Rectal Cancer Surgery: An Analysis of the US Rectal Cancer Consortium