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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 = 4404), prostate (n = 5334), or colorectal cancer (n = 4822) 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. Conclusion: The occurrence of unstaged cancer follows a systematic pattern of increase by age, Medicaid status, and COCN at baseline. (C) 2007 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved.