Hospital care trajectories of older adults with cancer and the associated clinical profiles.

Abstract

Background: The longitudinal hospital care experiences of older adults with cancer, from the treatment decision-making process until their end of life, remain unexplored. We examined the hospital care trajectories of these patients and identified associated clinical determinants.

Materials and methods: We linked the ELCAPA multicenter cohort study (patients aged ≥70 with a solid tumor and having been referred for a geriatric assessment between 2012 and 2019) and the Greater Paris University Hospitals' clinical data warehouse. Individual care trajectories, defined as series of consultations, hospital admissions (in day, acute, or rehabilitation units), and emergency room (ER) visits, were clustered using multichannel sequence analysis. Cluster membership determinants were identified among socio-demographic, oncological, and geriatric parameters by logistic regression analysis.

Results: Seven hundred seven patients (median age: 82; metastatic cancer: 45.2%; 10 998 care episodes) were included. Four trajectory clusters were identified: cluster A (n = 149, 21.1%) with in-hospital surgical trajectories, cluster B (n = 198, 28.0%) with outpatient care trajectories with chemotherapy and/or radiotherapy, cluster C (n = 302, 42.7%) without any hospital cancer treatments, and cluster D (n = 58, 8.2%) with mostly chemotherapy and high hospital care consumption. Cluster belonging determinants included metastatic status and cancer site (for cluster A); cognition, mobility, and mood status (unimpaired parameters for cluster B and impaired for cluster C); and younger age (for cluster D).

Conclusions: While highlighting varied hospital care experiences among older patients with cancer, we found that age remains an independent determinant of chemotherapy-dominant care trajectories.