Health Care Contact Days Experienced by Decedents With Advanced GI Cancer

Patel, Vishal R.; Ramesh, Vidhyalakshmi; Tsai, Alexander K.; Sedhom, Ramy; Westanmo, Anders D.; Blaes, Anne H.; Vogel, Rachel I.; Parsons, Helen M.; Hanna, Timothy P.; Ganguli, Ishani; Dusetzina, Stacie B.; Rocque, Gabrielle B.; Booth, Christopher M.; Gupta, Arjun

doi:10.1200/op.23.00232

Cited by 11 publications

(5 citation statements)

References 30 publications

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“…We included only 8 common laboratory tests; thus, the current contact days could be an underrepresentation. Despite this, we overcame a major limitation of prior single-center electronic health record–based studies: that those studies could not account for contact days outside that center . Second, the cohort studied represents a community practice population in a single Canadian province over 2014-2019, and contact day patterns in the US may differ due to different practice and payment patterns .…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, we overcame a major limitation of prior single-center electronic health record–based studies: that those studies could not account for contact days outside that center. 15 Second, the cohort studied represents a community practice population in a single Canadian province over 2014-2019, and contact day patterns in the US may differ due to different practice and payment patterns. 27 By including only decedents and limiting follow-up to 2 years, we might have biased the sample to those with shorter survival.…”

Section: Discussionmentioning

confidence: 99%

“…There is early evidence that patients with advanced cancers spend a large share of their days as health care contact days. For example, patients with advanced gastrointestinal cancer, with a median survival of 6 months, spend 1 in 4 days during this period receiving health care . Over the course of their illnesses, these contact days follow a U-shaped trajectory, with an initial peak, a middle trough, and a peak again as patients approach the end of life .…”

Section: Introductionmentioning

confidence: 99%

“…For example, patients with advanced gastrointestinal cancer, with a median survival of 6 months, spend 1 in 4 days during this period receiving health care. 6 , 15 Over the course of their illnesses, these contact days follow a U-shaped trajectory, with an initial peak, a middle trough, and a peak again as patients approach the end of life. 6 , 15 However, analyses have been limited to single centers with a limited variety of treatments.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 15 Over the course of their illnesses, these contact days follow a U-shaped trajectory, with an initial peak, a middle trough, and a peak again as patients approach the end of life. 6 , 15 However, analyses have been limited to single centers with a limited variety of treatments. Analyzing patterns of contact days in a large population-based cohort in a primary cancer site with different treatment approaches, including novel therapies purported to reduce patient burdens, would be informative to decision-makers, clinicians, and patients.…”

Section: Introductionmentioning

confidence: 99%

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Trajectories of Health Care Contact Days for Patients With Stage IV Non–Small Cell Lung Cancer

Gupta,

Nguyen,

Kain

et al. 2024

JAMA Netw Open

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ImportancePatients with stage IV non–small cell lung cancer (NSCLC) experience substantial morbidity and mortality. Contact days (ie, the number of days with health care contact outside the home) measure how much of a person’s life is consumed by health care, yet little is known about patterns of contact days for patients with NSCLC.ObjectiveTo describe the trajectories of contact days in patients with stage IV NSCLC and how trajectories vary by receipt of cancer-directed treatment in routine practice.Design, Setting, and ParticipantsA retrospective, population-based decedent cohort study was conducted in Ontario, Canada. Participants included adults aged 20 years or older who were diagnosed with stage IV NSCLC (January 1, 2014, to December 31, 2017) and died (January 1, 2014, to December 31, 2019); there was a maximum 2-year follow-up. Data analysis was conducted from February 22 to August 16, 2023.ExposureSystemic cancer-directed therapy (yes or no) and type of therapy (chemotherapy vs immunotherapy vs targeted therapy).Main Outcomes and MeasuresContact days (days with health care contact, outpatient or institution-based, outside the home) were identified through administrative data. The weekly percentage of contact days and fitted models with cubic splines were quantified to describe trajectories from diagnosis until death.ResultsA total of 5785 decedents with stage IV NSCLC were included (median age, 70 [IQR 62-77] years; 3108 [53.7%] were male, and 1985 [34.3%] received systemic therapy). The median overall survival was 108 (IQR, 49-426) days, median contact days were 36 (IQR, 21-62), and the median percentage that were contact days was 33.3%. A median of 5 (IQR, 2-10) days were spent with specialty palliative care. Patients who did not receive systemic therapy had a median overall survival of 66 (IQR, 34-130) days and median contact days of 28 (IQR, 17-44), of which a median of 5 (IQR, 2-9) days were spent with specialty palliative care. Overall and for subgroups, normalized trajectories followed a U-shaped distribution: contact days were most frequent immediately after diagnosis and before death. Patients who received targeted therapy had the lowest contact day rate during the trough (10.6%; vs immunotherapy, 15.4%; vs chemotherapy, 17.7%).Conclusions and RelevanceIn this cohort study, decedents with stage IV NSCLC had a median survival in the order of 3.5 months and spent 1 in every 3 days alive interacting with the health care system outside the home. These results highlight the need to better support patients and care partners, benchmark appropriateness, and improve care delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Trajectories of Health Care Contact Days for Patients With Stage IV Non–Small Cell Lung Cancer

Gupta,

Nguyen,

Kain

et al. 2024

JAMA Netw Open

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Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care

Gupta,

Johnson,

Henderson

et al. 2024

JAMA Netw Open

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ImportanceCancer and its care impose significant time commitments on patients and care partners. The oncology community has only recently conceptualized these commitments and the associated burden as the “time toxicity” of cancer care. As the concept gains traction, there is a critical need to fundamentally understand the perspectives of multiple stakeholders on the time burdens of cancer care.ObjectivesTo explore time-consuming aspects of cancer care that were perceived as burdensome, identify the individuals most affected by time burdens of cancer care, and evaluate the consequences of these time burdens.Design, Setting, and ParticipantsParticipants in this qualitative analysis were recruited from a National Cancer Institute–designated cancer center in Minnesota, where semistructured qualitative interviews were conducted from February 1 to October 31, 2023. Purposive and criterion sampling methods were used to recruit patients (adults with advanced stage gastrointestinal cancer receiving systemic cancer-directed treatment), care partners (patient-identified informal [unpaid] partners), and clinicians (physicians, physician assistants, nurse practitioners, nurses, social workers, and schedulers). Data were analyzed from February 2023 to February 2024.Main Outcomes and MeasuresThematic analysis was conducted with a hybrid (inductive and deductive methods) approach. Themes, subthemes, and illustrative quotations are presented.ResultsInterviews included 47 participants (16 patients [8 aged ≤60 years; 12 women (75.0%)], 15 care partners [12 aged ≤60 years; 9 women (60.0%)], and 16 clinicians [11 women (68.7%)]). A total of 31 subthemes were identified that were grouped into 5 themes. Theme 1 captured time burdens due to health care outside the home (eg, travel, parking, and waiting time), while theme 2 identified the often invisible tasks performed at home (eg, handling insurance and medical bills, receiving formal home-based care). Theme 3 explored how care partners are affected alongside patients (eg, burdens extending to the wider network of family, friends, and community) and theme 4 represented the consequences of time burdens (eg, demoralization, seemingly short visits turned into all-day affairs). Finally, theme 5 referenced positive time spent in clinical interactions and hope for change (eg, patients value meaningful care, the “time toxicity” label is a spark for change).Conclusions and RelevanceThis qualitative analysis identifies key sources and effects of time toxicity, as well as the populations affected. The results of this study will guide the oncology community to map, measure, and address future time burdens.

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Management of malignant bowel obstruction

Gupta

2024

The Lancet Gastroenterology & Hepatology

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Health Care Contact Days Experienced by Decedents With Advanced GI Cancer

Abstract: Patients with stage IV GI cancer spent 1 in 4 days alive with health care contact!

Cited by 11 publications

References 30 publications

Trajectories of Health Care Contact Days for Patients With Stage IV Non–Small Cell Lung Cancer

Trajectories of Health Care Contact Days for Patients With Stage IV Non–Small Cell Lung Cancer

Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care

Management of malignant bowel obstruction

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