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

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgments

This work was supported by Ontario Institute of Cancer Research (Grant P.HSR.156) and the Canadian Institute of Health Research (Grant #419,955). The authors thank the patient and family advisors, Grace Paladino and Pietrao Galluzzo, for their contributions to this work. This work was not pre-registered in an independent, institutional registry. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed in this report are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Members of the RESTORE-Cancer group: Laura Davis, MSc, Sunnybrook Research Institute; Ines Menjak, MD MSc, Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario; Dov Gandell, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Douglas Manuel, MD MSc, Ottawa Hospital Research Institute, Ottawa, Ontario; Frances Wright, MD MEd, Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario; Lesley Gotlib-Conn, PhD, Sunnybrook Research Institute, Toronto, Ontario; Grace Paladino, patient and family advisor; Pietrao Galluzzo, patient and family advisor.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Tyler R. Chesney MD, MSc, Barbara Haas MD, PhD, Natalie G. Coburn MD, MPH & Julie Hallet MD, MSc

  2. Division of General Surgery, Sunnybrook Health Sciences Centre – Odette Cancer Centre, Toronto, ON, Canada

    Barbara Haas MD, PhD, Natalie G. Coburn MD, MPH & Julie Hallet MD, MSc

  3. Sunnybrook Research Institute, Toronto, ON, Canada

    Barbara Haas MD, PhD, Natalie G. Coburn MD, MPH, Victoria Zuk MHSc & Julie Hallet MD, MSc

  4. ICES, Toronto, ON, Canada

    Barbara Haas MD, PhD, Natalie G. Coburn MD, MPH, Haoyu Zhao MPH & Julie Hallet MD, MSc

  5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Barbara Haas MD, PhD

  6. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Barbara Haas MD, PhD

  7. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Alyson L. Mahar PhD

  8. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Amy T. Hsu PhD

  9. Bruyère Research Institute, Ottawa, ON, Canada

    Amy T. Hsu PhD

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  1. Tyler R. Chesney MD, MSc
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  2. Barbara Haas MD, PhD
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  5. Victoria Zuk MHSc
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  6. Haoyu Zhao MPH
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Consortia

Recovery after Surgical Therapy for Older Adults Research–Cancer (RESTORE-Cancer) Group

  • Laura Davis MSc
  • , Ines Menjak MD, MSc
  • , Dov Gandell MD
  • , Douglas Manuel MD, MSc
  • , Frances Wright MD, MEd
  • , Lesley Gotlib-Conn PhD
  • , Grace Paladino
  •  & Pietrao Galluzzo

Corresponding author

Correspondence to Julie Hallet MD, MSc.

Ethics declarations

Julie Hallet has received speaking honoraria from Ipsen Biopharmaceuticals Canada and Novartis Oncology. Natalie G. Coburn receives salary support from Cancer Care Ontario as Lead for Patient-Reported Outcomes. The remaining authors have no conflicts of interest.

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Part of this work has been accepted for presentation at the annual meeting of the Society of Surgical Oncology to be held in Boston, MA, in March 2020.

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Chesney, T.R., Haas, B., Coburn, N.G. et al. Immediate and Long-Term Health Care Support Needs of Older Adults Undergoing Cancer Surgery: A Population-Based Analysis of Postoperative Homecare Utilization. Ann Surg Oncol 28, 1298–1310 (2021). https://doi.org/10.1245/s10434-020-08992-8

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