Choi Dong-Woo, Kim Seungju, Kim Dong Wook, Han Kyu-Tae
Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, 10408, Republic of Korea.
Department of Nursing, College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
J Cancer Res Clin Oncol. 2022 Sep;148(9):2323-2333. doi: 10.1007/s00432-022-04035-9. Epub 2022 May 6.
Fragmented cancer care (FC) means that patients visit multiple providers for treatment, which is common in cancer care. While FC is associated with poor health outcomes in patients with colorectal cancer (CRC) worldwide, there is still a lack of evidence in South Korea. We investigated the association between FC and 5-year morality in patients with CRC using population-based claims data.
The study population was followed up from 2002 to 2015. Data were collected from Korea National Health Insurance claims. Participants comprised patients with CRC diagnosed with International Classification of Diseases (ICD)-10 (C18.x-C20.x) and a special claim code for cancer (V193). Data were analyzed using the Kaplan-Meier curve with a log-rank test and Cox proportional hazard model. The effect of FC on patients' 5-year survival was examined.
Of 3467 patients with CRC, 20.0% had experienced FC. FC was significantly associated with an increased risk of 5-year mortality (hazard ratio 1.516, 95% confidence interval 1.274-1.804). FC was prevalent in those who had a low income level, underwent chemotherapy, did not undergo radiation therapy, and did not visit a tertiary hospital for their first treatment.
Efforts to decrease FC and integrate complex cancer care within appropriate healthcare delivery systems may improve survivorship among patients with CRC.
碎片化癌症护理（FC）是指患者为接受治疗而就诊于多个医疗机构，这在癌症护理中很常见。虽然在全球范围内，FC与结直肠癌（CRC）患者的不良健康结局相关，但韩国仍缺乏相关证据。我们使用基于人群的理赔数据，研究了FC与CRC患者5年死亡率之间的关联。
研究人群从2002年至2015年进行随访。数据收集自韩国国民健康保险理赔记录。参与者包括诊断为国际疾病分类（ICD）-10（C18.x-C20.x）且有癌症特殊理赔代码（V193）的CRC患者。采用Kaplan-Meier曲线结合对数秩检验和Cox比例风险模型进行数据分析。研究了FC对患者5年生存率的影响。
在3467例CRC患者中，20.0%经历过FC。FC与5年死亡率风险增加显著相关（风险比1.516，95%置信区间1.274-1.804）。FC在低收入水平、接受化疗、未接受放疗且首次治疗未就诊于三级医院的患者中普遍存在。
努力减少FC并在适当的医疗服务体系内整合复杂的癌症护理，可能会提高CRC患者的生存率。
