Geriatric Consultation Underused Before Surgical Removal of Kidney Cancer

08/29/17

Some health care services are rarely offered among older patients in the perioperative period for kidney cancer.

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Geriatric and related health care services provided to older adults undergoing surgery for kidney cancer is a potential growth area in geriatric oncology management. However, more data is necessary to understand the full extent of health care resource utilization in this population.

Hung-Jui Tan, MD, University of North Carolina at Chapel Hill, and colleagues conducted a population-based observational study to evaluate provisions of geriatric-related health care services by older adults undergoing surgery for kidney cancer. Researchers used Surveillance, Epidemiology, and End Results (SEER) cancer data regarding Medicare claims to sample 19,129 older adults (aged 65 years or older) with kidney cancer treated surgically from 2000 to 2009. Among the recorded health care services were receipt of geriatric consultation, medical co-management during the surgical hospitalization, inpatient physical or occupational therapy (PT/OT), and post-acute PT/OT during a surgical care episode.

Researchers used multivariable, mixed-effects models to identify associated participant and hospital characteristics, evaluate for trends over time, and classify hospital-level variation. Results of the study were published in the Journal of the American Geriatrics Society (online August 11, 2017; doi:10.1111/jgs.15046).

Researchers found that geriatric consultation occurred rarely in the perioperative (2.6%), while medical co-management (15.8%), inpatient PT/OT (34.2%), and post-acute PT/OT (15.6%) occurred more frequently. Mixed-effects models showed that participant age and comorbidity burden were consistent determinants of use of services, although hospital-level variation was also noted (P < .001).

In the latter years of the study, use of geriatric consultation increased modestly (P < .05), whereas medical co-management (183%), inpatient PT/OT (73%), and post-acute PT/OT (71%) increased substantially (P < .001).

Authors of the study concluded that while geriatric consultation has remained sparse for older adults undergoing surgery for kidney cancer, use of medical co-management and rehabilitation services have grown considerably. “Efforts to reorganize cancer and surgery care should explore reasons for variation and the potential for these service elements to meet the health needs of an aging population,” Dr Tan and colleagues wrote.—Zachary Bessette