Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Fragmented cancer care (FC), or care received from multiple institutions, increases systemic health care costs and potentiates cancer care disparities. There is a paucity of data on mechanisms contributing to FC and the resulting effect on patient outcomes. This study characterized patient- and hospital-level factors associated with FC, time to treatment (TTT), and overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: Patients newly diagnosed with HCC from 2004 to 2015 and receiving treatment were identified in the Texas Cancer Registry. Patient- and hospital-level factors were compared across 2 cohorts: an FC treatment group and a nonfragmented cancer care (NFC) treatment group. Covariate-adjusted treatment use and OS were compared between the 2 treatment groups. Results: Among 4329 patients with HCC, 1185 (27.4%) received FC, and 3144 (72.6%) received NFC. Compared with NFC patients, FC patients had larger tumors (median size ≥4 cm, 52.6% vs 35.2%; P <.001), and a higher proportion had a regional/metastatic stage (35.9% vs 26.7%; P <.001). Among patients with localized disease, FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95% confidence interval [CI], 0.7-0.9). FC was associated with worse OS (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24) and increased TTT (HR, 0.76; 95% CI, 0.7-0.8). In the subset of patients with localized-stage HCC who received curative therapy, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95% CI, 1.0-1.4) and increased TTT (HR, 0.74; 95% CI, 0.7-0.8). Conclusions: FC patients were less likely to undergo curative therapy when they were diagnosed at an early stage. After covariate adjustment, newly diagnosed patients with HCC receiving FC had worse OS and increased TTT.

Original languageEnglish (US)
JournalCancer
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hepatocellular Carcinoma
Survival
Neoplasms
Therapeutics
Confidence Intervals
Patient Care
Health Care Costs
Registries
Odds Ratio

Keywords

  • cancer care
  • fragmentation
  • hepatocellular carcinoma (HCC)
  • survival time to treatment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{3cbdfbf939bd4b119415c559a40969eb,
title = "Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma",
abstract = "Background: Fragmented cancer care (FC), or care received from multiple institutions, increases systemic health care costs and potentiates cancer care disparities. There is a paucity of data on mechanisms contributing to FC and the resulting effect on patient outcomes. This study characterized patient- and hospital-level factors associated with FC, time to treatment (TTT), and overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: Patients newly diagnosed with HCC from 2004 to 2015 and receiving treatment were identified in the Texas Cancer Registry. Patient- and hospital-level factors were compared across 2 cohorts: an FC treatment group and a nonfragmented cancer care (NFC) treatment group. Covariate-adjusted treatment use and OS were compared between the 2 treatment groups. Results: Among 4329 patients with HCC, 1185 (27.4{\%}) received FC, and 3144 (72.6{\%}) received NFC. Compared with NFC patients, FC patients had larger tumors (median size ≥4 cm, 52.6{\%} vs 35.2{\%}; P <.001), and a higher proportion had a regional/metastatic stage (35.9{\%} vs 26.7{\%}; P <.001). Among patients with localized disease, FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95{\%} confidence interval [CI], 0.7-0.9). FC was associated with worse OS (hazard ratio [HR], 1.14; 95{\%} CI, 1.05-1.24) and increased TTT (HR, 0.76; 95{\%} CI, 0.7-0.8). In the subset of patients with localized-stage HCC who received curative therapy, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95{\%} CI, 1.0-1.4) and increased TTT (HR, 0.74; 95{\%} CI, 0.7-0.8). Conclusions: FC patients were less likely to undergo curative therapy when they were diagnosed at an early stage. After covariate adjustment, newly diagnosed patients with HCC receiving FC had worse OS and increased TTT.",
keywords = "cancer care, fragmentation, hepatocellular carcinoma (HCC), survival time to treatment",
author = "Hester, {Caitlin A.} and Nishika Karbhari and Rich, {Nicole E.} and Mathew Augustine and Mansour, {John C.} and Polanco, {Patricio M.} and Porembka, {Matthew R.} and Wang, {Sam C.} and Zeh, {Herbert J.} and Singal, {Amit G.} and Yopp, {Adam C.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/cncr.32336",
language = "English (US)",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma

AU - Hester, Caitlin A.

AU - Karbhari, Nishika

AU - Rich, Nicole E.

AU - Augustine, Mathew

AU - Mansour, John C.

AU - Polanco, Patricio M.

AU - Porembka, Matthew R.

AU - Wang, Sam C.

AU - Zeh, Herbert J.

AU - Singal, Amit G.

AU - Yopp, Adam C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Fragmented cancer care (FC), or care received from multiple institutions, increases systemic health care costs and potentiates cancer care disparities. There is a paucity of data on mechanisms contributing to FC and the resulting effect on patient outcomes. This study characterized patient- and hospital-level factors associated with FC, time to treatment (TTT), and overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: Patients newly diagnosed with HCC from 2004 to 2015 and receiving treatment were identified in the Texas Cancer Registry. Patient- and hospital-level factors were compared across 2 cohorts: an FC treatment group and a nonfragmented cancer care (NFC) treatment group. Covariate-adjusted treatment use and OS were compared between the 2 treatment groups. Results: Among 4329 patients with HCC, 1185 (27.4%) received FC, and 3144 (72.6%) received NFC. Compared with NFC patients, FC patients had larger tumors (median size ≥4 cm, 52.6% vs 35.2%; P <.001), and a higher proportion had a regional/metastatic stage (35.9% vs 26.7%; P <.001). Among patients with localized disease, FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95% confidence interval [CI], 0.7-0.9). FC was associated with worse OS (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24) and increased TTT (HR, 0.76; 95% CI, 0.7-0.8). In the subset of patients with localized-stage HCC who received curative therapy, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95% CI, 1.0-1.4) and increased TTT (HR, 0.74; 95% CI, 0.7-0.8). Conclusions: FC patients were less likely to undergo curative therapy when they were diagnosed at an early stage. After covariate adjustment, newly diagnosed patients with HCC receiving FC had worse OS and increased TTT.

AB - Background: Fragmented cancer care (FC), or care received from multiple institutions, increases systemic health care costs and potentiates cancer care disparities. There is a paucity of data on mechanisms contributing to FC and the resulting effect on patient outcomes. This study characterized patient- and hospital-level factors associated with FC, time to treatment (TTT), and overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: Patients newly diagnosed with HCC from 2004 to 2015 and receiving treatment were identified in the Texas Cancer Registry. Patient- and hospital-level factors were compared across 2 cohorts: an FC treatment group and a nonfragmented cancer care (NFC) treatment group. Covariate-adjusted treatment use and OS were compared between the 2 treatment groups. Results: Among 4329 patients with HCC, 1185 (27.4%) received FC, and 3144 (72.6%) received NFC. Compared with NFC patients, FC patients had larger tumors (median size ≥4 cm, 52.6% vs 35.2%; P <.001), and a higher proportion had a regional/metastatic stage (35.9% vs 26.7%; P <.001). Among patients with localized disease, FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95% confidence interval [CI], 0.7-0.9). FC was associated with worse OS (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24) and increased TTT (HR, 0.76; 95% CI, 0.7-0.8). In the subset of patients with localized-stage HCC who received curative therapy, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95% CI, 1.0-1.4) and increased TTT (HR, 0.74; 95% CI, 0.7-0.8). Conclusions: FC patients were less likely to undergo curative therapy when they were diagnosed at an early stage. After covariate adjustment, newly diagnosed patients with HCC receiving FC had worse OS and increased TTT.

KW - cancer care

KW - fragmentation

KW - hepatocellular carcinoma (HCC)

KW - survival time to treatment

UR - http://www.scopus.com/inward/record.url?scp=85068925821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068925821&partnerID=8YFLogxK

U2 - 10.1002/cncr.32336

DO - 10.1002/cncr.32336

M3 - Article

C2 - 31299089

AN - SCOPUS:85068925821

JO - Cancer

JF - Cancer

SN - 0008-543X

ER -