Healthcare Contact Highest at Diagnosis, End-of-Life for Advanced GI Cancers

Healthcare contact was higher at diagnosis and at end-of-life among veterans with advanced gastrointestinal (GI) malignancies. These findings, from a retrospective study, were published in The Oncologist.

Contact with the healthcare system can be time consuming, which can be problematic for patients at the end of life. Therefore, researchers sought to identify patterns of contact days experienced by veterans with stage IV gastrointestinal cancer.

Data for this study were sourced from the Veterans Affairs (VA) Clinical Cancer Registry and the Corporate Data Warehouse. A total of 468 decedents with stage IV GI cancers who died between 2011 and 2021 were evaluated for days of contact with the healthcare system from diagnosis to death.

The patients were median age 69 years (IQR, 64 to 76) at diagnosis, 98.9% were men, 82.3% were White, and they had a Charlson comorbidity index of 2 (IQR, 1 to 3). The most common primary cancers were gastroesophageal (31.1%), pancreatic (28.3%), colorectal (25.5%), and hepatobiliary (14.9%).

The median overall survival was 126 days (IQR, 49 to 317), during which time most were hospitalized (88.2%) and received emergency care (65.8%) and nearly half (46.6%) received any cancer-directed treatment.

During the disease course, 34.9% of days were spent in contact with the healthcare system. Most visits (61.4%) were ambulatory.

Most contact days occurred immediately after diagnosis (45%) and before death (32%), forming a U shape. The depth of the trough in the U deepened as survival increased.

Greater contact with the healthcare system associated with comorbidity index (adjusted odds ratio [OR], 1.09), whereas rural location associated with decreased contact (OR, 0.76).

The results of this study may not be generalizable outside the VA system.

The study authors concluded, “[P]atients had a median survival of 4 months and spent 1 in 3 days with healthcare contact. Contact days followed a U-shaped trajectory and varied by clinical and sociodemographic factors.”