Association between gastrointestinal symptoms and specialty care utilization among colon cancer survivors: a cohort study.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Anya L Edwards, Karen Trang, Irina V Tolstykh, Erin L Van Blarigan, Katherine Van Loon, Angela Laffan, Dalila Stanfield, Paige Steiding, John Neuhaus, Chloe E Atreya, Sorbarikor Piawah, Alan P Venook, Madhulika G Varma
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引用次数: 0

Abstract

Purpose: Persistent gastrointestinal (GI) symptoms are frequently experienced by colon cancer survivors and may help identify patients with higher utilization of healthcare services. To assess the relationship between GI symptoms and specialty care utilization among colon cancer survivors.

Methods: A prospective longitudinal cohort study at an academic medical center of 126 adults surgically treated for stage I-IV colon cancer between February 2017 and June 2022. Participants reported GI symptoms through the EORTC QLQ-C30 and QLQ-CR29 at enrollment and as frequently as every 6 months for 5 years. Main outcome measures were visits, telephone encounters, and secure messages with a medical provider within specialty oncology clinics within 6 months after each survey completion. Generalized linear mixed regression model for repeated measurements with random trajectory for each participant was performed to estimate the associations between symptoms and healthcare use. Models were adjusted for demographics, clinical and surgical factors, and timing in relation to onset of the COVID-19 pandemic.

Results: In the 6 months after each survey time point, patients averaged 1.2 visits, 0.5 telephone encounters, and 3.2 patient-initiated messages. In adjusted models, those with any abdominal pain (RR 1.45; p = 0.002), buttock pain (RR 1.30; p = 0.050), or increased stool frequency (RR 1.26; p = 0.046) had more clinic visits in the following 6 months than those without these symptoms. Including these three symptoms in one model revealed that only abdominal pain was statistically significantly associated with increased clinic visits (RR 1.36; p = 0.016). Patients with any blood or mucus in stool (RR 2.46; p = 0.009) had significantly more telephone encounters, and those with any abdominal pain (RR 1.65; p = 0.002) had significantly more patient-initiated messages than those without these symptoms.

Conclusions: Our findings identify GI symptoms associated with increased use of oncologic specialty care among colon cancer survivors, with abdominal pain as an important predictor of utilization.

Implications for cancer survivors: Early identification and anticipatory management of colon cancer survivors experiencing abdominal pain may decrease healthcare utilization.

Abstract Image

结肠癌幸存者的胃肠道症状与使用专科护理之间的关系:一项队列研究。
目的:结肠癌幸存者经常会出现持续性胃肠道(GI)症状,这些症状可能有助于确定哪些患者需要更多的医疗服务。目的:评估结肠癌幸存者的胃肠道症状与使用专科医疗服务之间的关系:在一家学术医疗中心对 2017 年 2 月至 2022 年 6 月间接受 I-IV 期结肠癌手术治疗的 126 名成人进行前瞻性纵向队列研究。参与者在入组时通过 EORTC QLQ-C30 和 QLQ-CR29 报告消化道症状,并在 5 年内每 6 个月报告一次。主要结果测量指标为每次调查完成后 6 个月内肿瘤专科门诊医疗服务提供者的就诊、电话咨询和安全信息。为估计症状与医疗服务使用之间的关系,对每位参与者采用随机轨迹重复测量的广义线性混合回归模型。模型根据人口统计学、临床和手术因素以及与 COVID-19 大流行相关的时间进行了调整:结果:在每个调查时间点之后的 6 个月内,患者平均就诊 1.2 次,电话就诊 0.5 次,患者主动发送信息 3.2 条。在调整后的模型中,腹痛(RR 1.45;P = 0.002)、臀部疼痛(RR 1.30;P = 0.050)或大便次数增多(RR 1.26;P = 0.046)的患者在随后 6 个月中的就诊次数多于无上述症状的患者。将这三种症状纳入一个模型后发现,只有腹痛与就诊次数增加有显著统计学相关性(RR 1.36;P = 0.016)。与没有这些症状的患者相比,有便血或粘液的患者(RR 2.46;p = 0.009)的电话就诊次数明显增多,有腹痛的患者(RR 1.65;p = 0.002)的患者主动发送的信息明显增多:我们的研究结果表明,消化道症状与结肠癌幸存者使用肿瘤专科护理的增加有关,而腹痛是预测使用率的重要因素:对癌症幸存者的启示:对出现腹痛的结肠癌幸存者进行早期识别和预期管理可减少医疗服务的使用。
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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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