Older adults who see a PCP soon after cancer surgery have lower mortality risk
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Key takeaways:
- A postoperative primary care visit may reduce mortality risk among older adults who undergo cancer surgery.
- More than one-quarter of patients in the cohort did not have a PCP at the time of surgery.
Older patients who had a primary care visit within 90 days after cancer surgery exhibited significantly reduced mortality risk, according to retrospective study results.
However, nearly 30% of patients in the study population did not have a primary care practitioner at the time of surgery.
"I was astonished by the considerable difference in risk [for] death between patients who saw their primary care provider within 3 months of cancer surgery [and] those who did not," researcher Hadiza S. Kazaure, MD, endocrine surgeon at Duke Cancer Center, told Healio. "The results of our study had a clear message: Our older [patients with cancer] need to have primary care, but it is even more critical for them to see a primary care provider after cancer surgery."
Background and methods
About 75% of cancer survivors in the U.S. are aged 65 years or older. Many have comorbidities that necessitate both oncologic and nononcologic care, according to study background.
Older adults who undergo cancer surgery also are at greater risk for complications and functional deterioration, making primary care particularly important.
"There are so few studies focused on how primary care influences the survival of older patients undergoing cancer surgery," Kazaure said. "We know that primary care is important throughout life, that one in three Americans will be diagnosed with cancer in their lifetime, and that surgery is often a part of cancer treatment. Yet, even though we have an aging population and a large number of older patients undergo surgery to treat cancer, we know so little about the role primary care plays in that critical 3-month period after cancer surgery."
Kazaure and colleagues assessed the association between primary care use and mortality among older adults who underwent inpatient surgery for one of 12 cancer types at Duke University Health System between 2017 and 2019.
The cohort included 2,566 patients aged at least 65 years (mean age, 72.9 years; 51.5% men; 74.3% white). Nearly all (93.7%) had medical insurance but more than one-quarter (28.9%) had no PCP.
Ninety-day postoperative mortality served as the primary endpoint.
Results and next steps
Researchers reported mortality rates of 1.1% at 30 days, 1.8% at 60 days and 2.5% at 90 days.
Results showed significantly reduced rates of inpatient mortality (0.5% vs. 1.2%, P = .007) and 90-day postoperative mortality (2% vs. 3.6%, P = .01) among patients who had a PCP.
Analyses of 823 patients with a PCP who continued care at Duke following surgery showed 400 (48.6%) had a PCP visit within 90 days (median time to visit, 34 days; interquartile range, 20-57).
Individuals who had a postoperative PCP visit were older, had higher comorbidity burden, visited the ED more frequently and were readmitted more often than those who did not have a postoperative PCP visit. However, results showed a significantly lower 90-day postoperative mortality rate among those who had a PCP visit (0.3% vs. 3.3%, P = .001).
Race, gender, health insurance coverage and urgency of surgery did not affect mortality.
Researchers acknowledged several study limitations, including its retrospective and single-institution design. They also noted a lack of data on comorbidity severity, medication use, laboratory data, and reasons for PCP visits, ED visits and hospital readmissions.
Future research should investigate reasons why many older adults with cancer do not have a PCP, Kazaure said.
"Our study identified two slightly different problems — one related to having primary care and the other to primary care use after cancer surgery," Kazaure said. "Both issues are complex, but there is a low-hanging fruit: As cancer care providers, we can improve how we coordinate care with our patient's primary care providers in our daily practice. This may entail a simple message or setting up a routine system to update primary care providers about how the patient did after surgery and what concerns we may have going forward."
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