Does fragmented cancer care affect survival? Analysis of gastric cancer patients using national insurance claim data

BMC Health Services Research

Research

Dong-Woo Choi¹  Sun Jung Kim²  Dong Wook Kim³  Yoon-Jung Chang⁴  Kyu-Tae Han⁴  Dong Jun Kim⁵ 

[1] Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Goyang-Si, Republic of Korea;Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan-Si, Republic of Korea;Department of Information and Statistics, RINS, Gyeongsang National University, 501 Jinju-daero, Jinju-si, Gyeongsangnam-do, South Korea;Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Goyang-Si, Republic of Korea;Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea;

关键词: Fragmented cancer care;    cancer policy;    Healthcare utilization;    Survival;   

DOI  :  10.1186/s12913-022-08988-y

 received in 2022-07-20, accepted in 2022-12-19,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundWe aimed to investigate the association between fragmented cancer care in the early phase after cancer diagnosis and patient outcomes using national insurance claim data.MethodsFrom a nationwide sampled cohort database, we identified National Health Insurance beneficiaries diagnosed with gastric cancer (ICD-10: C16) in South Korea during 2005–2013. We analyzed the results of a multiple logistic regression analysis using the generalized estimated equation model to investigate which patient and institution characteristics affected fragmented cancer care during the first year after diagnosis. Then, survival analysis using the Cox proportional hazard model was conducted to investigate the association between fragmented cancer care and five-year mortality.ResultsOf 2879 gastric cancer patients, 11.9% received fragmented cancer care by changing their most visited medical institution during the first year after diagnosis. We found that patients with fragmented cancer care had a higher risk of five-year mortality (HR: 1.310, 95% CI: 1.023–1.677). This association was evident among patients who only received chemotherapy or radiotherapy (HR: 1.633, 95% CI: 1.005–2.654).ConclusionsFragmented cancer care was associated with increased risk of five-year mortality. Additionally, changes in the most visited medical institution occurred more frequently in either patients with severe conditions or patients who mainly visited smaller medical institutions. Further study is warranted to confirm these findings and examine a causal relationship between fragmented cancer care and survival.

【 授权许可】

CC BY   
© The Author(s) 2022

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