Complexity of care needs and unstaged cancer in elders: a population-based study.
BACKGROUND
Little is known about the contribution of older patients' complexity of care needs (COCN) to unstaged cancer, or incomplete evaluation of the extent of disease. We aimed at examining the association between the patients' COCN at baseline and unstaged cancer.


METHODS
The study used linked databases consisting of the Ohio Cancer Incidence Surveillance System (OCISS), Medicare and Medicaid enrollment files, the home health care Outcome and Assessment Information Set (OASIS), and the Long Term Care Minimum Data Set (MDS). The study population included patients 65 years of age or older diagnosed with incident breast (n=4,404), prostate (n=5,334), or colorectal cancer (n=4,822) in year 2000. The outcome of interest was unstaged cancer. Patients were identified with high COCN if they were admitted to a nursing home, with moderate COCN if they received home health services, and with low COCN if they were neither admitted to a nursing home nor received home health services, at baseline, or in the 6 months prior to cancer diagnosis. We employed logistic regression analyses to evaluate the independent association between COCN and unstaged cancer after adjusting for patient demographics and socioeconomic attributes.


RESULTS
The proportion of unstaged cases increased significantly with older age, by Medicaid status, and by COCN at baseline. Compared with patients with low COCN, those with higher complexity were four to five times as likely to have unstaged cancer.


CONCLUSIONS
The occurrence of unstaged cancer follows a systematic pattern of increase by age, Medicaid status, and COCN at baseline.
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4945, United States. skoroukian@case.edu
Siran M
SM
Koroukian
Fang
F
Xu
Heather
H
Beaird
Mireya
M
Diaz
Patrick
P
Murray
Julia H
JH
Rose
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006301:Health Services Needs and Demand; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008484:Medicaid; D009367:Neoplasm Staging; D009735:Nursing Homes; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D012959:Socioeconomic Factors