Does fragmented cancer care affect survival? Analysis of gastric cancer patients using national insurance claim data

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Abstract

Background

We aimed to investigate the association between fragmented cancer care in the early phase after cancer diagnosis and patient outcomes using national insurance claim data.

Methods

From a nationwide sampled cohort database, we identified National Health Insurance beneficiaries diagnosed with gastric cancer (ICD-10: C16) in South Korea during 2005–2013. We analyzed the results of a multiple logistic regression analysis using the generalized estimated equation model to investigate which patient and institution characteristics affected fragmented cancer care during the first year after diagnosis. Then, survival analysis using the Cox proportional hazard model was conducted to investigate the association between fragmented cancer care and five-year mortality.

Results

Of 2879 gastric cancer patients, 11.9% received fragmented cancer care by changing their most visited medical institution during the first year after diagnosis. We found that patients with fragmented cancer care had a higher risk of five-year mortality (HR: 1.310, 95% CI: 1.023–1.677). This association was evident among patients who only received chemotherapy or radiotherapy (HR: 1.633, 95% CI: 1.005–2.654).

Conclusions

Fragmented cancer care was associated with increased risk of five-year mortality. Additionally, changes in the most visited medical institution occurred more frequently in either patients with severe conditions or patients who mainly visited smaller medical institutions. Further study is warranted to confirm these findings and examine a causal relationship between fragmented cancer care and survival.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08988-y.

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Most cited references 26

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Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

E.C. Smyth, M Verheij, W Allum … (2016)

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Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.

Thierry André, Corrado Boni, Lamia Mounedji-Boudiaf … (2004)

The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin (FL). Oxaliplatin improves the efficacy of this combination in patients with metastatic colorectal cancer. We evaluated the efficacy of treatment with FL plus oxaliplatin in the postoperative adjuvant setting. We randomly assigned 2246 patients who had undergone curative resection for stage II or III colon cancer to receive FL alone or with oxaliplatin for six months. The primary end point was disease-free survival. A total of 1123 patients were randomly assigned to each group. After a median follow-up of 37.9 months, 237 patients in the group given FL plus oxaliplatin had had a cancer-related event, as compared with 293 patients in the FL group (21.1 percent vs. 26.1 percent; hazard ratio for recurrence, 0.77; P=0.002). The rate of disease-free survival at three years was 78.2 percent (95 percent confidence interval, 75.6 to 80.7) in the group given FL plus oxaliplatin and 72.9 percent (95 percent confidence interval, 70.2 to 75.7) in the FL group (P=0.002 by the stratified log-rank test). In the group given FL plus oxaliplatin, the incidence of febrile neutropenia was 1.8 percent, the incidence of gastrointestinal adverse effects was low, and the incidence of grade 3 sensory neuropathy was 12.4 percent during treatment, decreasing to 1.1 percent at one year of follow-up. Six patients in each group died during treatment (death rate, 0.5 percent). Adding oxaliplatin to a regimen of fluorouracil and leucovorin improves the adjuvant treatment of colon cancer. Copyright 2004 Massachusetts Medical Society

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Is Open Access

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2019

Mee Kang, Young-Joo Won, Jae Jun Lee … (2022)

Purpose The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2019. Materials and Methods Incidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2019, with survival follow-up until December 31, 2020. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea. Results In 2019, newly diagnosed cancer cases and deaths from cancer were reported as 254,718 (age-standardized rate [ASR], 275.4 per 100,000) and 81,203 (ASR, 72.2 per 100,000), respectively. For the first time, lung cancer (n=29,960) became the most frequent cancer in Korea, excluding thyroid cancer. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% annually from 2012 to 2015, thereafter, followed by nonsignificant changes. The incidence of thyroid cancer increased again from 2016 (annual percentage change, 6.2%). Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.7% from 2002 to 2013; 3.3% from 2013 to 2019). The 5-year relative survival between 2015 and 2019 was 70.7%, which contributed to prevalent cases reaching over 2 million in 2019. Conclusion Cancer survival rates have improved over the past decades, but the number of newly diagnosed cancers is still increasing, with some cancers showing only marginal improvement in survival outcomes. As the number of cancer survivors increases, a comprehensive cancer control strategy should be implemented in line with the changing aspects of cancer statistics.

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Author and article information

Contributors

Kyu-Tae Han: kthan.phd@gmail.com

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 21 December 2022

Publication date PMC-release: 21 December 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 1566

Affiliations

[1 ]GRID grid.410914.9, ISNI 0000 0004 0628 9810, Cancer Big Data Center, , National Cancer Control Institute, National Cancer Center, ; Gyeonggi-do, Goyang-Si, Republic of Korea

[2 ]GRID grid.412674.2, ISNI 0000 0004 1773 6524, Department of Health Administration and Management, , College of Medical Science, Soonchunhyang University, ; Asan-Si, Republic of Korea

[3 ]GRID grid.411947.e, ISNI 0000 0004 0470 4224, Graduate School of Public Health and Healthcare Management, , The Catholic University of Korea, ; Seoul, Republic of Korea

[4 ]GRID grid.410914.9, ISNI 0000 0004 0628 9810, Division of Cancer Control and Policy, , National Cancer Control Institute, National Cancer Center, ; Gyeonggi-do, Goyang-Si, Republic of Korea

[5 ]GRID grid.256681.e, ISNI 0000 0001 0661 1492, Department of Information and Statistics, , RINS, Gyeongsang National University, ; 501 Jinju-daero, Jinju-si, Gyeongsangnam-do South Korea

Article

Publisher ID: 8988

DOI: 10.1186/s12913-022-08988-y

PMC ID: 9773508

PubMed ID: 36544140

SO-VID: 9b45b655-c7b2-436c-ae4e-f880cdc2c0e5

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 July 2022

Date accepted : 19 December 2022

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: fragmented cancer care,cancer policy,healthcare utilization,survival

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ScienceOpen disciplines: Health & Social care

Keywords: fragmented cancer care, cancer policy, healthcare utilization, survival

Does fragmented cancer care affect survival? Analysis of gastric cancer patients using national insurance claim data

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Abstract

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Supplementary Information

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Most cited references 26

Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2019

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