Patterns of health care utilization preceding a colorectal cancer diagnosis are strong predictors of dying quickly following diagnosis

Abstract

BackgroundUnderstanding the predictors of a quick death following diagnosis may improve timely access to palliative care. The objective of this study was to explore whether factors in the 24 months prior to a colorectal cancer (CRC) diagnosis predict a quick death post-diagnosis.MethodsData were from a longitudinal study of all adult persons diagnosed with CRC in Nova Scotia, Canada, from 01Jan2001-31Dec2005. This study included all persons who died of any cause by 31Dec2010, except those who died within 30 days of CRC surgery (n = 1885 decedents). Classification and regression tree models were used to explore predictors of time from diagnosis to death for the following time intervals: 2, 4, 6, 8, 12, and 26 weeks from diagnosis to death. All models were performed with and without stage at diagnosis as a predictor variable. Clinico-demographic and health service utilization data in the 24 months pre-diagnosis were provided via linked administrative databases.ResultsThe strongest, most consistent predictors of dying within 2, 4, 6, and 8 weeks of CRC diagnosis were related to health services utilization in the 24 months prior to diagnosis: i.e., number of specialist visits, number of days spent in hospital, and number of family physician visits. Stage at diagnosis was the strongest predictor of dying within 12 and 26 weeks of diagnosis.ConclusionsIdentifying potential predictors of a short timeframe between cancer diagnosis and death may aid in the development of strategies to facilitate timely and appropriate referral to palliative care upon a cancer diagnosis.

Health service use and costs in the last 6 months of life in elderly decedents with a history of cancer: a comprehensive analysis from a health payer perspective

“…For instance, future end-of-life treatment guidelines may need to be tailored to multi-morbid patients rather than single diseases such as cancer. However, there is also evidence that specific diseases may influence the end-of-life trajectory; for example a recent study showed that frail patients (those with conditions such as dementia and Alzheimer's disease prior to a cancer diagnosis) died sooner following a cancer diagnosis compared with non-frail patients ( Urquhart et al , 2015 ). Although we did not examine frailty specifically, our results suggest that certain populations may have more complex end-of-life needs, for example, populations that survive for a shorter time following cancer diagnosis were more likely to be admitted to hospital or visit the ED in the last 6 months of life which may suggest that existing community or home care services are not meeting the needs of these patients.…”

“…For the purposes of identifying targets for resource allocation to improve end-of-life care, research supports consideration of broader quality indicators (i.e., indicators outside the hospital setting and before the last month of life) ( Langton et al , 2014 ). For example, the volume of health services use in the period before cancer diagnosis has been found to predict the time from cancer diagnosis to death ( Urquhart et al , 2015 ). The nature of health service use is also important as there is increasing evidence suggesting that continuity of primary care and interventions such as multidisciplinary case conferences involving palliative care teams can reduce subsequent ED visits and hospitalisations and may result in more cost-effective care overall ( Burge et al , 2003 ; Abernethy et al , 2013 ; Almaawiy et al , 2014 ; Seow et al , 2016 ).…”

Prediagnostic Prescription Antibiotics Use and Survival in Patients with Colorectal Cancer: A Swedish National Register-Based Study

“…Antibiotics users may represent a group of patients under more health care surveillance, or who more actively seek and receive health care (including cancer screening). This could, potentially, result in an earlier colorectal cancer diagnosis and better survival outcomes ( 35 ). Indeed, in our study, patients who had used antibiotics were diagnosed at lower stages.…”

Counties eliminating racial disparities in colorectal cancer mortality

“…58 The ongoing use of primary care may be an especially important predictor of the likelihood of cancer screening as well as stage at diagnosis. 59 In a retrospective cohort study of older patients diagnosed with CRC between 1994 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare-linked database, Ferrante et al found that patients with 5 to 10 primary care physician visits had a 16% lower CRC mortality (adjusted HR, 0.84; 95% CI, 0.80-0.88) and a 6% lower all-cause mortality (adjusted HR, 0.94; 95% CI, 0.91-0.97) than patients with only 0 to 1 visits. 60 A case-control study by the same authors confirmed these results of lower CRC mortality (adjusted OR, 0.78; 95% CI, 0.75-0.82) and lower all-cause mortality (adjusted OR, 0.79; 95% CI, 0.76-0.82) for patients with 5 to 10 primary care visits versus those with only 0 to 1 visits.…”