Geriatric assessment and care for older cancer inpatients admitted in acute care for elders unit

https://doi.org/10.1016/j.critrevonc.2008.04.001Get rights and content

Abstract

Purpose

The goal of this study was to characterize an elderly population admitted to an Acute Care for Elders Unit (ACE) and to determine their trajectory as well as the prevalence of functional dependencies.

Design and methods

We conducted a retrospective chart review of 186 older cancer inpatients, admitted over a period of 30 months. Demographic and oncologic data, reasons for admission, and geriatric assessment (comorbidity, dependency, medication, nutritional status, neurosensory deficits, cognition, mood, and mobility) were recorded.

Results

Older cancer inpatients presented a high prevalence of disability, impaired mobility, malnutrition, and depression. Reasons for admission were mostly due to non-specific symptoms. For one-third of the patients, hospitalization led to the diagnosis of cancer. Patients already diagnosed with cancer presented advanced stage disease and progressive disease; only a few received specific care.

Conclusion

Older cancer inpatients seen in ACE present numerous geriatric problems, non-specific symptoms, and advanced disease.

Introduction

Cancer is predominantly a disease of the elderly [1], [2]. More than 60% of all incident cases of cancer and more than 70% of all deaths from malignant tumors occur in older individuals. Studies in oncology have indicated that older cancer patients are healthier than the traditional geriatric patients [3], [4] and are quite similar to younger cancer patients [5], [6]. This suggests that cancers are more likely to be diagnosed in healthier rather than in frail older persons or that patients referred to the oncologist have already been selected for their fewer comorbidities by the primary care or referring physician. While the incidence of cancer increases with age and the elderly population is the fastest growing population, available data for older cancer patients, especially those outside the oncologic setting, remains very low.

Only two studies have assessed inpatients in Geriatric Evaluation and Management Units (GEMU). Rao et al. identified 99 patients with cancer in a subset analysis of a randomized control trial including 1388 frail elderly patients [7]. Garman et al. identified 36 older cancer patients of a total of 102 patients hospitalized during the same period [8]. Thus, the percentage of older cancer patients admitted to GEMU fluctuates approximately between 7% and 35%. Using the national Minimum Data Set (MDS), Buchanan et al. analyzed more than 548,000 nursing home admission assessments and found that 11.3% of these residents had a diagnosis of cancer upon admission to the nursing facility [9]. Moreover, in these three studies, older cancer patients presented a high prevalence of disability, comorbidity, and cognitive impairment. In a previous study [4] we found that 21% of patients admitted to an internal medicine Acute Care for Elders Unit (ACE) had an active cancer. Compared to non-cancer inpatients, cancer inpatients had fewer comorbidities, but were more depressed and malnourished. This suggests that cancer inpatients differ from the traditional geriatric inpatient and require specific care and management. All these results indicated that a vast part of the older cancer population is misunderstood and the selected oncologic, older cancer populations included in studies are not representative of all cancer patients. There is, therefore, a lack of data on the health, functional status, and goals of care of older cancer patients seen outside the oncologic care setting, and especially of those admitted to acute medical units.

The aim of this study was to present a comprehensive profile of geriatric cancer inpatients, including socio-demographic and oncologic characteristics, as well as measures of health and functional status, admitted to an internal medicine Acute Care for Elders Unit (ACE).

Section snippets

Study setting, sample, and design

Cancer inpatients, aged 65 years and over, hospitalized in the ACE of the University Hospital Center (Marseilles, France) between January 2003 and June 2006 were included in this retrospective chart review. During this period, 1218 patients were admitted to the unit. Of those, 186 were cancer patients. Cancer patients were defined as those diagnosed with an active cancer (solid tumor or hematological malignancies) either before or after admission. Patients with non-melanoma skin cancer or with

Results

Between January 2003 and June 2006, 1218 patients, aged 65 years and over, were admitted to the unit. Of those, a total of 186 patients (15%) had an active cancer. The mean age of cancer patients was 79.5 years (standard deviation (S.D.) ± 7.4). More than half the patients were female.

Table 1 presents the demographics and cancer characteristics of patients. Almost two-thirds of the patients lived at home prior to admission. One-third was admitted after a stay at the emergency department.

Discussion

Our study showed that older cancer inpatients seen in an ACE present a high prevalence of disability, impaired mobility, malnutrition, depression and require specific care and management. The reasons for admission to the unit are mostly due to non-specific signs or symptoms. For one-third of patients, hospitalization led to the diagnosis of cancer. Patients already diagnosed with cancer presented with advanced stage disease or progressive disease; only few received specific care.

Several studies

Reviewers

Professor Hubert Blain, Centre de Prévention et de Traitement des Maladies du Vieillissement Antonin, Balmes 39 avenue Charles Flahault, Montpellier Cedex 5 F-34295, France

Conflict of interest

The authors do not have any conflict of interest to declare.

Acknowledgements

The authors are grateful to Dr. H. Bergman and the Solidage research group for editorial assistance and to the physician, nurses, staff, and Internal Medicine Acute Care for Elders Unit team members for supporting this project.

Dr. Frederique Retornaz is currently a physician at H. Sainte-Marguerite, Marseilles, France. She is completing her doctorate at the Mediterranean University and has a degree in internal medicine, geriatrics, and oncology. Dr. Retornaz is the recipient of a Bourse Lavoisier from the French Ministry of Foreign Affairs. She has completed a 1-year fellowship in the division of Geriatric Medicine at McGill University, culminating in a research project that focused on the detection of vulnerability

References (39)

  • R. Bernabei et al.

    The comprehensive geriatric assessment: when, where, how

    Crit Rev Oncol Hematol

    (2000)
  • C.C. Chen et al.

    Utilization of comprehensive geriatric assessment in cancer patients

    Crit Rev Oncol Hematol

    (2004)
  • Canadian Cancer Society/National Cancer Institute of Canada. Canadian Cancer Statistics 2006. Toronto, Canada:...
  • L. Repetto et al.

    Performance status and comorbidity in older cancer patients compared with young patients with neoplasia and older patients without neoplastic conditions

    Cancer.

    (1998)
  • F. Retornaz et al.

    Comparison of the health and functional status between older inpatients with and without cancer admitted to a geriatric/internal medicine unit

    J Gerontol A Biol Sci Med Sci

    (2007)
  • B. Given et al.

    Physical functioning of older cancer patients prior to diagnosis and following initial treatment

    Nurs Res

    (2001)
  • S.S. Ingram et al.

    Comprehensive assessment of the older cancer patient: the feasibility of self-report methodology

    J Clin Oncol

    (2002)
  • A.V. Rao et al.

    Geriatric evaluation and management units in the care of the frail elderly cancer patient

    J Gerontol A Biol Sci Med Sci

    (2005)
  • R.J. Buchanan et al.

    Analyses of nursing home residents with cancer at admission

    Cancer Nurs

    (2005)
  • Cited by (0)

    Dr. Frederique Retornaz is currently a physician at H. Sainte-Marguerite, Marseilles, France. She is completing her doctorate at the Mediterranean University and has a degree in internal medicine, geriatrics, and oncology. Dr. Retornaz is the recipient of a Bourse Lavoisier from the French Ministry of Foreign Affairs. She has completed a 1-year fellowship in the division of Geriatric Medicine at McGill University, culminating in a research project that focused on the detection of vulnerability in older cancer patients. Dr. Retornaz continues to conduct research dealing with older cancer patients seen in the geriatric department.

    Dr. Valerie Seux is a fellow at H. Sainte-Marguerite, Marseilles, France. She has a degree in internal medicine and geriatrics.

    Vanessa Pauly is a statistician at H. Sainte-Marguerite, Marseille, France.

    Dr. Jacques Soubeyrand is chief of the Department of Internal Medicine and Geriatrics at H. Sainte-Marguerite, and professor at the Mediterranean University, Marseille, France.

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