Hospital Care Trajectories of Older Adults with Cancer and the Associated Clinical Profiles: linking a French Prospective Cohort Study and a Clinical Data Warehouse

Abstract

AbstractBackgroundThe 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.MethodsWe 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 visits, were clustered using multichannel sequence analysis. Cluster membership determinants were identified among socio-demographic, oncological and geriatric parameters by logistic regression analysis.Results707 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).ConclusionWhile highlighting varied hospital care experiences among older patients with cancer, we found that age remains an independent determinant of chemotherapy-dominant care trajectories.