Healthcare utilization trajectory among survivors of colorectal cancer
Menée aux Etats-Unis à partir de données portant sur des patients ayant survécu à un cancer colorectal diagnostiqué entre 2014 et 2016 (âge médian au diagnsotic : 54 ans), cette étude analyse l'évolution de leur utilisation des soins de santé, avant et jusqu'à 3 ans après le diagnostic
Purpose : To examine healthcare utilization patterns among patients < 65 y with colorectal cancer (CRC) from pre-diagnosis to 3 y into survivorship. Methods : Truven Health Analytics MarketScan Commercial Claims and Encounters Database was used to identify patients diagnosed with non-metastatic CRC between 2014 and 2016, with follow-up until 12/31/2019. Total visits (inpatient and outpatient) were estimated for 6 months intervals from 2 y to 1 months prior to CRC diagnosis (pre-cancer phase) and from a 1-y post-cancer diagnosis to a 3-y post-cancer diagnosis (survivorship phase). Utilization patterns from pre- to post-diagnosis were defined using median and 75th percentile visit counts. Interrupted time series (ITS) analyses examined pre- and post-cancer diagnosis utilization trends. Multivariable regression models estimated pre-cancer factors associated with high and low utilization patterns. Results : Median age at CRC was 54 y (21–62); 50.6% of the patients were male, 30.9% were diagnosed with rectal cancer. ITS analyses demonstrated four utilization patterns with distinct pre- and post-cancer diagnosis utilization trends. Rectal cancer (RR = 1.13, p < 0.001) and high pre-cancer utilization (RR = 2.05, p < 0.001) were associated with a greater risk of high survivor phase utilization. Gastrointestinal conditions accounted for the greatest proportion of visits in pre-cancer phase (18%) and survivorship (17%), followed by cardiovascular disease (10% and 8%). Conclusions : Distinct patterns of healthcare utilization are observed both in the pre-cancer phase and survivorship phase of colorectal cancer and are influenced by cancer location, age, therapeutic exposures, and prior healthcare needs. Implications for Cancer Survivors : Not all patients will require the same level or type of long-term follow-up. Identifying indication-specific healthcare utilization patterns that provide evidence for risk stratification may facilitate a more patient-centric and economically sustainable way to deliver care.