Healthcare utilization trajectory among survivors of colorectal cancer

Kelly M Kenzik; Grant R Williams; Robert Hollis; Smita Bhatia

doi:10.1007/s11764-022-01206-y

Healthcare utilization trajectory among survivors of colorectal cancer

J Cancer Surviv. 2023 Jun;17(3):729-737. doi: 10.1007/s11764-022-01206-y. Epub 2022 Apr 2.

Authors

Kelly M Kenzik^{1

2}, Grant R Williams^{3

4}, Robert Hollis³, Smita Bhatia^{3

5}

Affiliations

¹ Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA. kkenzik@uab.edu.
² Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA. kkenzik@uab.edu.
³ Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Division of Pediatric Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 35366740
DOI: 10.1007/s11764-022-01206-y

Abstract

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 75^th 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.

Keywords: Colorectal cancer; Healthcare utilization trajectory; Morbidity; Risk-stratified care.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cancer Survivors*
Colorectal Neoplasms* / pathology
Colorectal Neoplasms* / therapy
Delivery of Health Care
Female
Humans
Male
Patient Acceptance of Health Care
Rectal Neoplasms*
Survivors

Grants and funding

K08CA234225/NH/NIH HHS/United States