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

• Published in: BMC health services research Vol. 22; no. 1; p. 1566
• Main Authors: Choi, Dong-Woo, Kim, Sun Jung, Kim, Dong Jun, Chang, Yoon-Jung, Kim, Dong Wook, Han, Kyu-Tae
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.12.2022; BioMed Central; BMC
• Subjects: Beneficiaries; Cancer; cancer policy; Cancer survivors; Cancer therapies; Care and treatment; Chemotherapy; Clinical outcomes; Diagnosis; Economic aspects; Fragmented cancer care; Gastric cancer; Health aspects; Health care expenditures; Health insurance; Health services utilization; Healthcare utilization; Hospitals; Humans; Independent variables; Insurance; Insurance claims; Insurance coverage; Medical care; Medical diagnosis; Mortality; National health insurance; Patient outcomes; Patients; Population; Proportional Hazards Models; Radiation therapy; Retrospective Studies; Rural areas; Services; Social aspects; Stomach cancer; Stomach Neoplasms - therapy; Surgery; Survival; Survival Analysis; Utilization; South Korea; cancer policy; Healthcare utilization; Fragmented cancer care; Survival
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08988-y

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. 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. 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). 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.