Long-term Health-Care Utilisation in Older Patients with Cancer and the Association with the Geriatric 8 Screening Tool: a Retrospective Analysis Using Linked Clinical and Population-Based Data in Belgium.

Background Little evidence is available on the long-term health-care utilisation of older patients with cancer and whether this is associated with geriatric screening results. We aimed to evaluate long-term health-care utilisation among older patients after cancer diagnosis and the association with baseline Geriatric 8 (G8) screening results. Methods For this retrospective analysis, we included data from three cohort studies for patients (aged >= 70 years) with a new cancer diagnosis who underwent G8 screening between Oct 19, 2009 and Feb 27, 2015, and who survived more than 3 months after G8 screening. The clinical data were linked to cancer registry and health-care reimbursement data for long-term follow-up. The occurrence of outcomes (inpatient hospital admissions, emergency department visits, use of intensive care, contacts with general practitioner [GP], contacts with a specialist, use of home care, and nursing home admissions) was assessed in the 3 years after G8 screening. We assessed the association between outcomes and baseline G8 score (normal score [>14] or abnormal [<= 14]) using adjusted rate ratios (aRRs) calculated from Poisson regression and using cumulative incidence calculated as a time-to-event analysis with the Kaplan-Meier method. Findings 7556 patients had a new cancer diagnosis, of whom 6391 patients (median age 77 years [IQR 74-82]) met inclusion criteria and were included. 4110 (64 center dot 3%) of 6391 patients had an abnormal baseline G8 score (<= 14 of 17 points). In the first 3 months after G8 screening, health-care utilisation peaked and then decreased over time, with the exception of GP contacts and home care days, which remained high throughout the 3-year follow-up period. Compared with patients with a normal baseline G8 score, patients with an abnormal baseline G8 score had more hospital admissions (aRR 1 center dot 20 [95% CI 1 center dot 15-1 center dot 25]; p<0 center dot 0001), hospital days (1 center dot 66 [1 center dot 64-1 center dot 68]; p<0 center dot 0001), emergency department visits (1 center dot 42 [1 center dot 34-1 center dot 52]; p<0 center dot 0001), intensive care days (1 center dot 49 [1 center dot 39-1 center dot 60]; p<0 center dot 0001), general practitioner contacts (1 center dot 19 [1 center dot 17-1 center dot 20]; p<0 center dot 0001), home care days (1 center dot 59 [1 center dot 58-1 center dot 60]; p<0 center dot 0001), and nursing home admissions (16 center dot 7% vs 3 center dot 1%; p<0 center dot 0001) in the 3-year follow-up period. At 3 years, of the 2281 patients with a normal baseline G8 score, 1421 (62 center dot 3%) continued to live at home independently and 503 (22 center dot 0%) had died. Of the 4110 patients with an abnormal baseline G8 score, 1057 (25 center dot 7%) continued to live at home independently and 2191 (53 center dot 3%) had died. Interpretation An abnormal G8 score at cancer diagnosis was associated with increased health-care utilisation in the subsequent 3 years among patients who survived longer than 3 months.