Jean Charline, Paillaud Elena, Boudou-Rouquette Pascaline, Martinez-Tapia Claudia, Pamoukdjian Frédéric, Hagège Meoïn, Bréant Stéphane, Hassen-Khodja Claire, Natella Pierre-André, Cudennec Tristan, Laurent Marie, Caillet Philippe, Audureau Etienne, Canouï-Poitrine Florence
Université Paris-Est Créteil, Inserm, IMRB U955, 94010 Créteil, France.
Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service Santé Publique & Unité de Recherche clinique, 94010 Créteil, France.
Oncologist. 2025 Mar 10;30(3). doi: 10.1093/oncolo/oyae301.
The longitudinal hospital care experiences of older adults with cancer, from the treatment decision-making process until their end of life, remain unexplored. We examined the hospital care trajectories of these patients and identified associated clinical determinants.
We linked the ELCAPA multicenter cohort study (patients aged ≥70 with a solid tumor and having been referred for a geriatric assessment between 2012 and 2019) and the Greater Paris University Hospitals' clinical data warehouse. Individual care trajectories, defined as series of consultations, hospital admissions (in day, acute, or rehabilitation units), and emergency room (ER) visits, were clustered using multichannel sequence analysis. Cluster membership determinants were identified among socio-demographic, oncological, and geriatric parameters by logistic regression analysis.
Seven hundred seven patients (median age: 82; metastatic cancer: 45.2%; 10 998 care episodes) were included. Four trajectory clusters were identified: cluster A (n = 149, 21.1%) with in-hospital surgical trajectories, cluster B (n = 198, 28.0%) with outpatient care trajectories with chemotherapy and/or radiotherapy, cluster C (n = 302, 42.7%) without any hospital cancer treatments, and cluster D (n = 58, 8.2%) with mostly chemotherapy and high hospital care consumption. Cluster belonging determinants included metastatic status and cancer site (for cluster A); cognition, mobility, and mood status (unimpaired parameters for cluster B and impaired for cluster C); and younger age (for cluster D).
While highlighting varied hospital care experiences among older patients with cancer, we found that age remains an independent determinant of chemotherapy-dominant care trajectories.
老年癌症患者从治疗决策过程到生命终结的纵向医院护理经历仍未得到充分研究。我们研究了这些患者的医院护理轨迹，并确定了相关的临床决定因素。
我们将ELCAPA多中心队列研究（2012年至2019年间年龄≥70岁、患有实体瘤且被转诊进行老年评估的患者）与大巴黎大学医院的临床数据仓库相链接。将个体护理轨迹定义为一系列会诊、住院（日间、急症或康复病房）和急诊室就诊，采用多通道序列分析进行聚类。通过逻辑回归分析在社会人口统计学、肿瘤学和老年医学参数中确定聚类成员的决定因素。
纳入了707例患者（中位年龄：82岁；转移性癌症：45.2%；10998次护理事件）。确定了四个轨迹聚类：聚类A（n = 149，21.1%）为院内手术轨迹，聚类B（n = 198，28.0%）为有化疗和/或放疗的门诊护理轨迹，聚类C（n = 302，42.7%）无任何医院癌症治疗，聚类D（n = 58，8.2%）主要为化疗且医院护理消耗高。聚类归属的决定因素包括转移状态和癌症部位（聚类A）；认知、活动能力和情绪状态（聚类B的参数未受损，聚类C受损）；以及较年轻的年龄（聚类D）。
在强调老年癌症患者不同的医院护理经历的同时，我们发现年龄仍然是化疗为主的护理轨迹的独立决定因素。
