Dell Medical School, The University of Texas at Austin, Austin, TX.
University of Minnesota, Minneapolis, MN.
JCO Oncol Pract. 2023 Nov;19(11):1031-1038. doi: 10.1200/OP.23.00232. Epub 2023 Sep 22.
Frequent visits to health care facilities can be time intensive and all-consuming for people with cancer. We measured health care contact days (days with healthcare contact outside the home) among decedents with advanced GI cancer and examined sources of contact days, their associations with demographic and clinical factors, and their temporal patterns over the course of illness.
We conducted a retrospective cohort study using a tumor registry and electronic medical record data for decedents with stage IV GI cancer between 2011 and 2019 in a large health care network in MN. We determined contact days from diagnosis to death using chart review. Using multivariable beta regression adjusted for sociodemographic and clinical characteristics offset by survival, we calculated adjusted estimates of contact days and determined patient-level factors associated with percentage of contact days.
We identified 809 patients eligible for analysis (median [IQR] age at diagnosis, 65 [56-73] years). The median (IQR) overall survival was 175 (56-459) days. Patients spent a median (IQR) of 25.8% (17.4%-39.1%) of these as contact days. Of these days, 83.6% were spent on outpatient visits. In the multivariable analysis, older age, Black race, and never receiving systemic cancer-directed treatment were associated with a higher percentage of contact days. The percentage of contact days was highest in the first month after diagnosis (39.6%) and before death (32.2%), with a more moderate middle phase (U-shaped curve).
Decedents with advanced GI cancer spend 1 in 4 days alive with health care contact, despite a median survival of under 6 months. This is even higher immediately postdiagnosis and near death. These findings highlight the need to understand sources of variation, benchmark appropriate care, and deliver more efficient care for this vulnerable population with limited time.
频繁前往医疗机构可能会耗费癌症患者大量的时间和精力。本研究旨在测量晚期胃肠道癌症患者的医疗接触天数（即除在家以外的医疗接触天数），并探讨接触天数的来源、其与人口统计学和临床因素的关联，以及疾病过程中的时间模式。
我们采用回顾性队列研究，使用明尼苏达州一家大型医疗保健网络的肿瘤登记处和电子病历数据，分析了 2011 年至 2019 年间确诊为 IV 期胃肠道癌症的患者。我们通过病历回顾确定了从诊断到死亡的接触天数。通过多变量β回归调整人口统计学和临床特征的生存偏移，计算了接触天数的调整估计值，并确定了与接触天数百分比相关的患者水平因素。
我们共纳入了 809 名符合条件的患者（诊断时的中位[IQR]年龄为 65[56-73]岁）。中位（IQR）总生存期为 175（56-459）天。患者的中位（IQR）医疗接触天数占总生存天数的 25.8%（17.4%-39.1%）。在这些接触天数中，83.6%是在门诊就诊时花费的。在多变量分析中，年龄较大、黑人种族和从未接受系统的癌症定向治疗与更高的接触天数百分比相关。接触天数百分比在诊断后第一个月最高（39.6%），接近死亡时（32.2%）最高，中间阶段（U 型曲线）较为适中。
尽管晚期胃肠道癌症患者的中位生存期不足 6 个月，但仍有 1/4 的存活天数需要进行医疗保健接触。这种情况在诊断后和接近死亡时更为严重。这些发现强调了需要了解变化的来源，为这一脆弱人群提供基准适当的护理，并提供更高效的护理，因为他们的时间有限。
