Healthcare contact days for patients with stage IV non-small cell lung cancer (NSCLC) in Ontario: A population-based study.

Abstract

484 Background: For people with advanced NSCLC, visits to healthcare facilities can impose time burdens and take over patients’ lives, especially in the context of limited survival. It is unclear if time burdens vary based on use and type of systemic therapy. We sought to describe patterns of contact days— days with any in-person healthcare contact as a measure of potential time toxicity—in a population-based sample. Methods: We created a population-based, retrospective decedent cohort with health administrative data covering the population of Ontario, Canada (15 million), of adults aged ≥20 years diagnosed with stage IV NSCLC in 2014-2017 and died in 2014-2019. We stratified analysis by systemic therapy received (yes vs no), type of systemic therapy: chemotherapy, immunotherapy, or targeted therapy, and lines received (one, two). The primary outcome was contact days measured from diagnosis to death. We calculated percentage contact days as contact days divided by overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified 5,785 stage IV NSCLC patients (median age, 70 years, 46.3% female, 57.8% adenocarcinoma, 34.3% received systemic therapy). The median (IQR) survival was 108 days (49-426) and median percentage of contact days 33.3%. Median [IQR] overall survival was longer in patients who received systemic therapy vs. not (261 [152-420] days, vs. 66 [34-130] days). The median percentage of contact days was lower in those who received systemic therapy vs. not (22.2% vs. 40.9%). Overall and for subgroups (systemic therapy vs no, type of therapy, receiving one or two lines), normalized trajectories followed a U-shaped distribution, with highest rates immediately following diagnosis, and prior to death, with a lower middle-phase. The difference between the maximal peak and trough was greater in patients who received systemic therapy (peak 34.8% vs trough 15.9%, ‘’deeper U’’) vs. not (39.5% vs 27.6%, ‘’shallower U’’). The trough was slightly lower for targeted therapy (12.3%, vs 15.9% immunotherapy, vs. 17.7% chemotherapy). Conclusions: Patients with stage IV NSCLC spent a significant proportion of days alive with health care contact, with higher contact days immediately post-diagnosis and pre-death (U-shaped curve). Among those not receiving systemic therapy, the high percentage of contact days, short survival, and shallower U-shaped trajectory reflect their poor underlying health and steady need for supportive care. With systemic therapy, those receiving targeted therapy experienced slightly fewer contact days at the trough of their U-shaped trajectory. These data serve as a call to recognize patient time toxicity, improve care delivery efficiency, and better support patients during periods of high burden.