Healthcare trajectories following cancer surgery in older adults: insights from the French health data system

Healthcare trajectories of older patients with cancer, particularly after surgical treatment, remain poorly described. Understanding these trajectories is crucial for improving patient outcomes and optimizing healthcare resources. This study aimed to describe the one-year healthcare trajectories of older patients following cancer surgery in France and identify their determinants. This observational study was conducted using the French National Health Data System, a nationwide medico-administrative database. The study included 140,442 patients aged 75 years and older, identified through cancer diagnosis codes and surgical procedure classifications between 2018 and 2021. A multichannel sequence analysis was performed to cluster healthcare trajectories within one year post-surgery. A favourable trajectory was defined as having a low number of hospitalization days and deaths. A ridge-L2-penalized logistic regression model was employed to identify factors associated with each trajectory. Five distinct healthcare trajectory clusters were identified. The most prevalent trajectory (69.4%) was characterized by a low healthcare density, with a median one-year cumulative hospital length of stay of 12 days. Adverse trajectories were associated with older age, frailty, comorbidity, emergency admissions, prior chemotherapy, and some types of surgery (pancreas, lymph node dissection, bladder, esophagogastric, multiple sites). Cancer surgery for patients aged 75 years and older is predominantly associated with favourable outcomes and limited healthcare utilization. The use of trajectory analysis provides a comprehensive understanding of postoperative outcomes in this population, highlighting the impact of frailty, and may inform the development of new decision-making frameworks tailored to older adults with cancer.