General practitioner contacts, hospitalizations, and nursing home transfers in older patients up to three years after new cancer diagnosis: Results from a large data linkage cohort study.
Authors: Depoorter Victoria , Vanschoenbeek Katrijn , Decoster Lore , De Schutter Harlinde , Debruyne Philip R. , DeGroof Inge , Bron Dominique , Cornélis Frank , Luce Sylvie , Focan C. N. J. , Verschaeve Vincent , Debugne Gwenaelle , Langenaeken Christine M. L. H. , Van Den Bulck Heidi , Goeminne Jean-Charles , Milisen Koen , Flamaing Johan , Kenis Cindy , Verdoodt Freija , Wildiers Hans 
Published: June 2022

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Background: Long-term outcomes after cancer diagnosis in older persons are largely unexplored because of limited follow-up in clinical studies. By linking clinical data with population-based data, studying long-term outcomes in large cohorts becomes feasible. The current study aims to explore long-term outcomes in the care trajectory of older patients with cancer and to assess their association with baseline geriatric screening and assessment (GS/GA) results. Methods: A large cohort study of older patients with a new cancer diagnosis was set up by linking clinical, cancer registry and administrative health data based on a unique patient identifier. Clinical data were derived from a previously performed prospective multicentric Belgian study (2009-2015). Patients aged ≥ 70 years were screened with G8 followed by GA in case of an abnormal result (≤14/17). Tumor characteristics and vital status were derived from cancer registry data and long-term outcomes (general practitioner (GP) contacts, hospitalizations and nursing home transfers) from administrative health data. In patients that survived at least 3 months since inclusion, outcomes were assessed from the day after inclusion until 3 years after. Event rates were calculated using person-time at risk to allow for varying follow-up time. Patients were censored 3 months before death to exclude influence of end-of-life care. Results: After data linkage, 6,391 older patients with a new cancer diagnosis were available for this analysis. The median age was 77 (range: 70–100) and 59.8% was female. Diagnoses included solid (92.8%) and hematologic malignancies (7.2%). In the patients with a solid tumor, breast, colorectal and lung cancer were the most common and 20.1% of patients had stage IV. 64.3% of patients had an abnormal baseline G8 score. During the 3 year follow-up, 2,602 (40.7%) of the included patients died. In these 3 years, 5,985 (95.2%) patients had at least one contact with a GP and 4,634 (72.5%) had at least one new hospital admission (event rates in Table 1). Of the 3,724 patients living independently at inclusion and still alive after 3 years, 281 (7.5%) had been transferred to a nursing home and of those, 240 (85.4%) patients had an abnormal baseline G8 score. Conclusions: Older patients with an abnormal baseline G8 score have more GP contacts, hospital admissions and nursing home transfers in the 3 years following a new cancer diagnosis compared to patients with normal baseline G8 score. Baseline G8 could help identify patients at risk for higher long-term healthcare utilization.[Table: see text]