TOPLINE:

Older Americans with metastatic breast, colorectal, lung, or prostate cancer are spending an increasing amount of time in the healthcare system, driven mainly by treatments, tests, and clinician visits. The number of healthcare contact days rose between 2008 and 2019, with a notable jump in the ambulatory visits from 2016 onward.

METHODOLOGY:

• Older adults face substantial time burdens from cancer care, especially for metastatic cancers. As treatments and subspecialty care continue to expand and grow in complexity, it is important to understand the impact on patients’ time burden.
• Researchers used the Surveillance, Epidemiology, and End Results-Medicare linked database to analyze data on 55,806 Medicare beneficiaries aged 66 years or older who were diagnosed with metastatic breast, colorectal, lung, or prostate cancer.
• The primary outcome was the number of healthcare contact days in the year after diagnosis — the sum of days spent in ambulatory settings (clinician visits, tests, imaging, procedures, and treatments) and those spent in institutional settings (hospital, emergency department, skilled nursing facility, and inpatient hospice).
• Overall, 27,340 patients had lung cancer, 11,739 had prostate cancer, 10,232 had colorectal cancer, and 6495 had breast cancer. Most patients were non-Hispanic White (76.1%-81.1%), resided in metropolitan areas (54.8%-58%), and received chemotherapy and/or radiation therapy in the 180 days after diagnosis (52.6%-75.5%).

TAKEAWAY:

• Patients with colorectal cancer had the highest mean number of healthcare contact days (62.9 days), followed by those with lung (60.2 days), breast (48.7 days), and prostate (40.1 days) cancers.
• Days spent in ambulatory care comprised most contact days, with the highest and lowest mean number of ambulatory days for lung cancer (46.7 days) and prostate cancer (29.5 days), respectively. Treatment administration contributed the largest share, followed by clinician visits and tests.
• Across cancer types, healthcare contact days increased between 2008 and 2019; the greatest change was observed for breast cancer (from a mean of 44.9 days to 57.6 days). Time spent in ambulatory care rose notably from 2016 onward: from a mean of 35.8 days to 46.2 days for breast cancer, from 45.5 days to 55.6 days for colorectal cancer, from 46.2 days to 52.4 days for lung cancer, and from 31 days to 35.7 days for prostate cancer.
• Patient characteristics associated with more contact days included receipt of chemotherapy and/or radiation therapy in the 180 days after diagnosis, having one or more comorbidities, having low income, and being non-Hispanic White or Black.

IN PRACTICE:

“Increasing contact days observed during the study period should prompt oncology care teams to recognize the time burden associated with metastatic cancer care and consider expected healthcare contact days when discussing care goals and choosing treatment plans with patients,” the authors of the study wrote.

The study “acknowledges an often underappreciated burden — the substantial time our patients commit to cancer care,” wrote Sahil D. Doshi, MD, Memorial Sloan Kettering Cancer Center, New York City, and colleagues in an accompanying editorial. “These findings highlight the unmet need to address time toxicity and lay the foundation for innovative care delivery models to increase time at home.”

SOURCE:

The study, led by Arjun Gupta, MD, University of Minnesota, Minneapolis, was published online in JAMA Network Open.

LIMITATIONS:

The analysis focused exclusively on Medicare beneficiaries diagnosed with incident metastatic cancer, potentially limiting generalizability to patients younger than 66 years, those with other insurance types, and those with earlier-stage or recurrent cancer. Additionally, the study did not assess the appropriateness, quality, or efficiency of healthcare contact days.

DISCLOSURES:

The study received support through grant 23-20-GUPT from the Pancreatic Cancer Action Network. Some authors reported receiving grants from various sources. One author reported being a member of the Medicare Payment Advisory Commission. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.