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

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.

Cancer care coordination in rural Hawaii: a focus group study

“…Given that previous studies indicate that primary care physicians play a vital role in cancer CC by managing comorbid conditions [ 23 ], the pandemic is likely to have further exacerbated the high-turnover and challenges with finding general medical providers felt by the participants. Furthermore, other studies have also shown that fragmented cancer care results in longer time to treatment and increased mortality while potentiating existing socioeconomic disparities [ 24 , 25 ]. Some of the participants were worried about these delays because they feared further cancer progression.…”

Is Fragmented Cancer Care Associated With Medical Expenditure? Nationwide Evidence From Patients With Lung Cancer Using National Insurance Claim Data

“…In South Korea, recent studies have found that FC was associated with higher mortality among patients with various cancers [13][14][15]. Moreover, efforts to decrease FC and integrate complex cancer care within appropriate healthcare delivery systems may improve survivorship among patients with cancer [13,14].…”

“…In South Korea, recent studies have found that FC was associated with higher mortality among patients with various cancers [13][14][15]. Moreover, efforts to decrease FC and integrate complex cancer care within appropriate healthcare delivery systems may improve survivorship among patients with cancer [13,14]. In South Korea, there is no strict gatekeeping system for controlling healthcare utilization, and it is relatively easy for patients to access primary and secondary care and services in tertiary hospitals [16].…”