Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;19(11):1031-1038.
doi: 10.1200/OP.23.00232. Epub 2023 Sep 22.

Health Care Contact Days Experienced by Decedents With Advanced GI Cancer

Vishal R Patel  1 , Vidhyalakshmi Ramesh  2 , Alexander K Tsai  2 , Ramy Sedhom  3 , Anders D Westanmo  4 , Anne H Blaes  2 , Rachel I Vogel  2 , Helen M Parsons  2 , Timothy P Hanna  5 , Ishani Ganguli  6 , Stacie B Dusetzina  7   8 , Gabrielle B Rocque  9 , Christopher M Booth  10 , Arjun Gupta  2   11
Affiliations

Health Care Contact Days Experienced by Decedents With Advanced GI Cancer

Vishal R Patel et al. JCO Oncol Pract. 2023 Nov.

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

PubMed Disclaimer

Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Arjun Gupta

This author is a member of the JCO Oncology Practice Editorial Board. Journal policy recused the author from having any role in the peer review of this manuscript.

Employment: Genentech/Roche

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Percent of contact days for patients with stage IV GI cancer from diagnosis over the course of illness.
FIG 2.
FIG 2.
Percent of contact days for patients with stage IV GI cancer from diagnosis over the course of illness, by survival cohorts.
See this image and copyright information in PMC

References

    1. Bange EM, Doucette A, Gabriel PE, et al. : Opportunity costs of receiving palliative chemotherapy for metastatic pancreatic ductal adenocarcinoma. JCO Oncol Pract 16:e678-e687, 2020 - PMC - PubMed
    1. Gupta A, Jensen EH, Virnig BA, et al. : Time-related burdens of cancer care. JCO Oncol Pract 18:245-246, 2022 - PubMed
    1. Bynum JPW, Meara E, Chang C, et al. : Our parents, ourselves: Health care for an aging population. A report of the Dartmouth Atlas Project, 2016. https://data.dartmouthatlas.org/downloads/reports/Our_Parents_Ourselves_... - PubMed
    1. Fundytus A, Prasad V, Booth CM: Has the current oncology value paradigm forgotten patients' time?: Too little of a good thing. JAMA Oncol 7:1757-1758, 2021 - PubMed
    1. Gupta A, Eisenhauer EA, Booth CM: The time toxicity of cancer treatment. J Clin Oncol 40:1611-1615, 2022 - PubMed

Publication types

LinkOut - more resources