Age differences in care practices and outcomes for hospitalized patients with cancer

OBJECTIVE: To identify age group differences in care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN: Prospective cohort study (SUPPORT project). SETTING: Five United States teaching hospitals; data was gathered between 1 989 and 1994. SUBJECTS: Nine hundred twenty five older (age greater than or equal to 65 y ears), 983 middle aged (age = 45-64 years), and 274 younger (age = 18-44 ye ars) hospitalized patients receiving care for non-small cell lung cancer, c olon cancer metastasized to the liver, or multi-organ system failure associ ated with malignancy. MEASUREMENTS: Care practices and patient outcomes were determined from hosp ital records. Length of survival was identified using the National Death In dex. After adjusting for important variables, including severity of illness (i.e., SUPPORT model estimate for 2-month survival, cancer condition), hos pital site, selection to intervention and sociodemographic variables, age g roup differences in care practices and outcomes were identified using gener al linear models. RESULTS: Older patients with cancer had lower resource utilization during h ospitalization (P < .04) and were less likely to receive cancer-related tre atments (i.e., chemotherapy, platelet infusions, scheduled intravenous medi cations) than middle-aged and young-adult patients in the first week of hos pitalization (P < .01). More care topics were discussed with older patients and their families then with younger patients and their families (P < .001 ). Length of stay and total hospital costs were lower for older and middle- aged patients than for younger patients. Although more older patients had d iscussions about transfer to hospice (P < .001), older patients were no mor e likely to be discharged with supportive care (inpatient hospice or home w ith home/hospice care). Older patients died sooner than middle-aged patient s (P < .01). CONCLUSIONS: Patient age influenced care decisions and outcomes. Older pati ents (age greater than or equal to 65 years) received less aggressive care, had more discussions about care decisions, and died sooner than younger pa tients with cancer. Younger patients had longer stays, higher hospital cost s, and greater probability of rehospitalization. Although well over half of patients died within 6 months of hospitalization, few patients in any age group were discharged with supportive care. Future studies should examine a ge differences in palliation, as well as acute care of cancer patients acro ss inpatient and ambulatory care settings and should assess quality of care at the end of life.