Thong Melissa S Y, Boakye Daniel, Jansen Lina, Martens Uwe M, Chang-Claude Jenny, Hoffmeister Michael, Brenner Hermann, Arndt Volker
1Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg.
2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg.
J Natl Compr Canc Netw. 2021 Dec 7;20(5):468-478.e7. doi: 10.6004/jnccn.2021.7030.
Colorectal cancer (CRC) survivors generally have a higher healthcare utilization (HCU) than the general population due to cancer burden. However, it is unclear which factors are associated with this increased uptake. Our study aimed to (1) compare CRC-related and non-CRC visits to general practitioners (GPs) and medical specialists (MSs) by comorbidities, and (2) assess whether HCU differs by demographic, clinical, and psychological factors.
We used data from a German population-based cohort of 1,718 survivors of stage I-III CRC diagnosed in 2003 through 2010 who provided information on HCU at 5-year follow-up. Multivariable linear regression was used to calculate least-square means of CRC-related and non-CRC HCU according to the Charlson comorbidity index and comorbidity cluster, adjusting for relevant demographic, clinical, and psychological characteristics.
A higher comorbidity level was associated with more CRC-related MS visits and non-CRC GP visits. In addition to being strongly associated with non-CRC GP visits, comorbidity clusters were associated with CRC-related GP and MS visits, but their association varied by specific cardiometabolic comorbidities. HCU was less dependent on prognostic factors for CRC, such as age and tumor stage, but was strongly associated with disease recurrence, depression, and emotional functioning.
Comorbidities, rather than age or tumor stage, were related to HCU, suggesting that CRC survivors use healthcare mainly for reasons other than cancer 5 years postdiagnosis. Improved communication between primary and tertiary healthcare providers could enhance the medical care of cancer survivors with complex health needs and thereby also reduce healthcare costs.
由于癌症负担，结直肠癌（CRC）幸存者的医疗保健利用率（HCU）通常高于普通人群。然而，尚不清楚哪些因素与这种利用率增加相关。我们的研究旨在：（1）按合并症比较CRC相关和非CRC相关的全科医生（GP）及医学专家（MS）就诊情况，以及（2）评估HCU是否因人口统计学、临床和心理因素而异。
我们使用了来自德国一个基于人群队列的数据，该队列包含2003年至2010年诊断为I - III期CRC的1718名幸存者，他们在5年随访时提供了HCU信息。多变量线性回归用于根据查尔森合并症指数和合并症聚类计算CRC相关和非CRC相关HCU的最小二乘均值，并对相关人口统计学、临床和心理特征进行调整。
较高的合并症水平与更多的CRC相关MS就诊和非CRC相关GP就诊相关。除了与非CRC相关GP就诊密切相关外，合并症聚类还与CRC相关的GP和MS就诊相关，但其关联因特定的心脑血管代谢合并症而异。HCU对CRC的预后因素（如年龄和肿瘤分期）的依赖性较小，但与疾病复发、抑郁和情绪功能密切相关。
合并症而非年龄或肿瘤分期与HCU相关，这表明CRC幸存者在诊断后5年使用医疗保健主要是出于癌症以外的原因。改善初级和三级医疗保健提供者之间的沟通可以加强对有复杂健康需求的癌症幸存者的医疗护理，从而也降低医疗成本。
