According to a study published in the Journal of the American Medical Association Network Open, postoperative primary care visits may diminish risk of mortality among older adults who undergo cancer surgery.

The objective of the retrospective cohort survey was to assess primary care use among older surgical patients with cancer who underwent inpatient surgery for one of 12 cancer types and to establish its correlations with the risk of mortality. The types of cancer were colorectal, head and neck, prostate, ovarian, pancreatic, breast, liver, renal cell, non–small cell lung, endometrial, gastric, or esophageal cancer.

The authors wrote, “Multimorbidity and postoperative clinical decompensation are common among older surgical patients with cancer, highlighting the importance of primary care to optimize survival. Little is known about the association between primary care use and survivorship among older adults (aged ≥65 years) undergoing cancer surgery.”

Between January 1, 2017, and December 31, 2019, researchers gathered data from the electronic health record of a single healthcare system for older adults undergoing cancer surgery.

The researchers established three tiers of stratification, including 1) patients who had a primary care practitioner (PCP; physician, nurse practitioner, or physician assistant) versus patients who did not; 2) patients who had a PCP and underwent surgery in the same health system (unfragmented care) versus those who did not (fragmented care); and 3) those who had a primary care visit within 90 postoperative days versus those who did not obtain care from a PCP. The data were examined between August 2023 and January 2024.

The study included 2,566 older adults (mean [standard error of the mean] age, 72.9 [0.1] years; 1,321 men [51.5%]). The results revealed that while 2,404 patients (93.7%) had health insurance coverage, 743 (28.9%) had no PCP at the time of surgery. Among the study cohort, other common comorbidities were hypertension (1,685 [65.7%]), hyperlipidemia (1,318 [51.4%]), and diabetes (664 [25.9%]).

Compared with the PCP group, the no-PCP group exhibited a higher 90-day postoperative mortality rate (2.0% vs. 3.6%, respectively; adjusted P = .03). Among the 823 patients with unfragmented care, 400 (48.6%) had a primary care visit within 90 days post surgery (median time to visit was 34 days; interquartile range, 20-57 days). Patients who attended a postoperative primary care visit were generally older, had more comorbidities, visited the emergency department more frequently, and were more likely to be readmitted. However, they experienced a significantly lower 90-day postoperative mortality rate compared with those who did not have a primary care visit (0.3% vs. 3.3%, respectively; adjusted P = .001).

The authors concluded their findings suggest that postoperative primary care use may substantially improve survivorship after cancer surgery among older patients.

“More studies are needed to delineate extant care coordination patterns by cancer type as well as barriers to having a PCP and a primary care visit among older patients with cancer,” the authors concluded.

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