Healthcare contact days experienced by patients with advanced gastrointestinal cancer.

Abstract

477 Background: Frequent visits to healthcare facilities can be time consuming and resource intensive for people with cancer. We assessed patterns of in-person healthcare contact days among veterans with advanced gastrointestinal (GI) cancer. Methods: We conducted a retrospective cohort analysis using the Veterans Affairs Clinical Cancer Registry (VACCR) and Corporate Data Warehouse (CDW) to identify decedents with stage IV GI cancer between 2011 and 2021 at the Minneapolis VA Hospital, Minnesota, USA. We determined the nature of contact days (clinician visit, imaging, inpatient, etc.) from diagnosis to death by reviewing encounters in the electronic medical record. The primary outcome was the percentage of days with health care contact (contact days/overall survival). We calculated descriptive statistics and visualized the trajectory of percentage of contact days over time by standardizing differential survival from cancer diagnosis to death and fitting the observations to a cubic smoothing spline. Using multivariable beta regression, we analyzed for clinicodemographic factors associated with contact days. Results: We analyzed data for 468 patients (median [IQR] age at diagnosis 69 [64-76] years, 99% men, 82% white, 31% with gastroesophageal cancer and 47% with receipt of any cancer directed treatment). Median [IQR] overall survival was 126 [49-318] days and median [IQR] contact days were 44 [20-95], or 35% of survival days. Ambulatory clinician visits represented the largest source of contact days (61.4%). A majority (88%) of patients were hospitalized at least once, with a median of 13 total inpatient days. The highest percentage of contact days occurred immediately after diagnosis (45%) and prior to death (32%) with a more modest middle phase, forming a U-shaped curve. This pattern was consistent when stratifying by length of survival. Beta regression results are shown in Table 1. Conclusions: Veterans with advanced GI cancer had a median survival of four months and spent just over one third of their days receiving in-person healthcare. Contact days were highest post-diagnosis and pre-death. Higher co-morbidity burden, urban residence, later diagnosis period, and no cancer directed treatment were associated with increased contact days. These findings highlight the need to understand sources of variation, benchmark appropriate care, and improve efficiency of visits, especially at critical phases of care.[Table: see text]