Post-Acute Care among Older Adults with Stage I to III Colorectal Cancer

Kelly M. Kenzik, Grant R. Williams, Smita Bhatia, Courtney J. Balentine

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

BACKGROUND: Little information is available on the long-term use of post-acute care among older patients with colorectal cancer (CRC), relative to individuals without cancer. This study examines the use of post-acute care among older cancer survivors (>65 y) with CRC and compares it with noncancer patients up to 5 years from surgery. DESIGN: Retrospective cohort. SETTING: SEER-Medicare. PARTICIPANTS: Patients treated for stage I to III CRC between January 1, 2000, and December 31, 2011 (n = 40 812) and noncancer Medicare beneficiaries hospitalized for noncancer treatment matching on age, sex, race, comorbidity, and Medicaid dual eligibility. MEASUREMENTS: Incident post-acute care claims (skilled nursing, long-term care facility, and home health) from 0 to 100 days, 101 to 365 days, and 1 to 5 years from hospitalization. RESULTS: The median age was 77 years. All patients had surgery, 34% received chemotherapy, and 27% received surgery and adjuvant therapy. The cumulative incidence of any post-acute care within 100 days of hospitalization was 45.7% for stage III, 37.9% for stage I/II, and 39% for controls (p <.001). Within the CRC cohort only, the cumulative incidence of post-acute care was 2.9% (stage I/II) and 4.2% (stage III, p <.001) from 101 to 365 days and 15.8% (stage I/II) and 16.9% (stage III, p <.001) from 1 to 5 years. Increasing age, ostomies, and neoadjuvant or adjuvant therapy were associated with increased hazard of all post-acute patients within 100 days from hospitalization. From 1 to 5 years from diagnosis, adjuvant therapy was associated with greater exclusive home health care use. CONCLUSIONS: Survivorship planning among older CRC patients should include discussions of post-acute care following cancer therapy, even several years after treatment. J Am Geriatr Soc 67:937–944, 2019.

Original languageEnglish (US)
Pages (from-to)937-944
Number of pages8
JournalJournal of the American Geriatrics Society
Volume67
Issue number5
DOIs
StatePublished - May 2019

Keywords

  • care transitions
  • colorectal cancer
  • post-acute care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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