Trends in Aging-Related Services During Nephrectomy: Implications for Surgery in an Aging Population

Area of Science:

• Geriatric Medicine
• Surgical Oncology
• Health Services Research

Background:

• Older adults are a growing demographic undergoing surgery for kidney cancer.
• Geriatric and related healthcare services may improve surgical outcomes for this population.
• The provision of these services in kidney cancer surgery is not well-characterized.

Purpose of the Study:

• To characterize the utilization of geriatric and related healthcare services for older adults undergoing kidney cancer surgery.
• To examine trends and factors associated with the use of these services.
• To identify hospital-level variations in service provision.

Main Methods:

• Population-based observational study using Surveillance, Epidemiology, and End Results (SEER) cancer data linked with Medicare claims.
• Included adults aged 65 and older with kidney cancer treated surgically from 2000 to 2009.
• Analyzed receipt of geriatric consultation, medical comanagement, inpatient/postacute physical or occupational therapy (PT/OT) using multivariable, mixed-effects models.

Main Results:

• Geriatric consultation was infrequent (2.6%), but medical comanagement (15.8%), inpatient PT/OT (34.2%), and postacute PT/OT (15.6%) were more common.
• Participant age and comorbidity burden influenced service use, with notable hospital-level variation.
• Use of medical comanagement and rehabilitation services increased substantially over the study period (71-183%), while geriatric consultation saw modest growth.

Conclusions:

• While geriatric consultation remains underutilized, medical comanagement and rehabilitation services have seen significant growth for older adults undergoing kidney cancer surgery.
• Hospital-level variations in service provision warrant further investigation.
• These findings highlight the increasing integration of supportive care services for an aging surgical oncology population.