Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan

Abstract

ObjectivesCancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer.MethodsA total of 14,240 working-age patients (20 <age ≤65 years) with oral cavity cancer treated with radiotherapy (RT) during 2000–2013 were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database. We evaluated the effects of the Continuity of Care Index (COCI) proposed by Bice and Boxerman, sociodemographic factors, and comorbidities on the survival rate. This study categorized COC into three groups—low (COCI < 0.23), intermediate (COCI = 0.23–0.37), and high (COCI ≥ 0.38)—according to the distribution of scores in our sample. A multivariate Cox proportional hazards regression model was used to determine the demographic factors and comorbidities associated with the survival rate.ResultsAmong all the relevant variables, low COCI, male sex, low socioeconomic status, no receipt of prior dental treatment before RT, residence outside northern Taiwan, chemotherapy receipt, and a history of diabetes increased the risk of mortality. Pre-RT dental evaluation and management was significantly associated with reduced post-RT mortality (adjusted hazard ratio [aHR] = 0.767, 95% confidence interval [CI] = 0.729–0.806, p < 0.001). Compared with patients with a high COCI, those with a low COCI exhibited an increased risk of mortality (aHR = 1.170, 95% CI = 1.093–1.252, p < 0.001). The mortality risk in the intermediate COC group was significantly higher than that in the high COC group (aHR = 1.194, 95% CI = 1.127–1.266, p < 0.001). To balance the distribution of the potential risk factors, propensity-score matching was used for the high COC (COCI > 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074–1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107–1.277, p = 0.001, respectively).ConclusionsIn Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers’ attention.

Influence of Sociodemographic Factors, and the Coverage and Offer of Health Services on Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-year Analysis

“…These authors provide as justi cation for their ndings the exposure of women to smoking in more recent decades, as well as the exposure to HPV, mainly due to its relationship with oropharyngeal cancer. [31] Regarding the sex differences found in this study, the survival rate in men was signi cantly lower than that in women, as had already been identi ed in other countries [4,32]. Shiboski, when investigating racial disparities in survival rates, also identi ed disparities between the sexes; white women exhibited higher survival than men, both black and white, while black women had lower survival than white men [33].…”

“…However, some studies conducted in the Southeast and Northeast regions' capitals did not identify differences in survival between the sexes. [12,34,35] Clinical factors such as site of injury, histological type, staging of the disease, type of treatment, time between diagnosis and initiation of treatment, nutritional status, and HPV exposure, also in uence the survival of individuals with oral cancer, [4,12,14,34,36,37] which may justify the difference found in this study compared to other ndings in the literature. Another possible explanation is that the regular use of health services, speci cally by women, [8] which can enable early diagnosis, encounters barriers such as wrong diagnoses and erroneous and/or late referrals, which lead to late diagnosis, with consequent worsening of prognosis and survival.…”

“…[3] Approximately 370 000 new cases and 185 821 deaths have occurred in 2020, indicating that this neoplasm is a global public health problem. [4] In 2012, approximately 77% of deaths caused by oral cancer occurred in developing countries. [5] Among the continents, Latin America has the highest incidence rate, [6] wherein men from Cuba and Brazil had the highest age-adjusted incidence and mortality rates per 100 000 inhabitants.…”

Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

“…We applied the COCI developed by Bice and Boxerman to evaluate the COC status [23]. Several studies have used this method for COC investigation, extracting data from health care claim databases [24][25][26][27][28]. By using the COCI method, we could acquire the distribution of CP outpatient visits to different physicians, and visit times to each physician from the index date.…”

Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status

“…Lack of eradication of oral foci, poor oral hygiene, and poor dental and periodontal conditions increase the rate of side effects of HNSCC treatment (e.g. wound failure, development of osteoradionecrosis (ORN)) [14,[16][17][18][19] and might even negatively affect the mortality rate [20]. Hence, several reviews and recommendations have been recently published about the timepoint and extent of dental interventions during and after cancer treatment, to minimise the side effects caused by a poor oral health status [2,3,[5][6][7][8].…”