Healthcare utilization trajectory among survivors of colorectal cancer.

Abstract

To examine healthcare utilization patterns among patients < 65 y with colorectal cancer (CRC) from pre-diagnosis to 3 y into survivorship. Truven Health Analytics MarketScan Commercial Claims and Encounters Database was used to identify patients diagnosed with non-metastatic CRC between 2014 and 2016, with follow-up until 12/31/2019. Total visits (inpatient and outpatient) were estimated for 6months intervals from 2 y to 1months prior to CRC diagnosis (pre-cancer phase) and from a 1-y post-cancer diagnosis to a 3-y post-cancer diagnosis (survivorship phase). Utilization patterns from pre- to post-diagnosis were defined using median and 75th percentile visit counts. Interrupted time series (ITS) analyses examined pre- and post-cancer diagnosis utilization trends. Multivariable regression models estimated pre-cancer factors associated with high and low utilization patterns. Median age at CRC was 54 y (21-62); 50.6% of the patients were male, 30.9% were diagnosed with rectal cancer. ITS analyses demonstrated four utilization patterns with distinct pre- and post-cancer diagnosis utilization trends. Rectal cancer (RR = 1.13, p < 0.001) and high pre-cancer utilization (RR = 2.05, p < 0.001) were associated with a greater risk of high survivor phase utilization. Gastrointestinal conditions accounted for the greatest proportion of visits in pre-cancer phase (18%) and survivorship (17%), followed by cardiovascular disease (10% and 8%). Distinct patterns of healthcare utilization are observed both in the pre-cancer phase and survivorship phase of colorectal cancer and are influenced by cancer location, age, therapeutic exposures, and prior healthcare needs. Not all patients will require the same level or type of long-term follow-up. Identifying indication-specific healthcare utilization patterns that provide evidence for risk stratification may facilitate a more patient-centric and economically sustainable way to deliver care.