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Temporal trends in the treatment complexity of colorectal cancer at BC Cancer between 2000 and 2012

University of British Columbia

Background: Substantial advances in chemotherapy for colorectal cancer (CRC) occurred between 2000 and 2012, potentially contributing to increased treatment complexity. The objective of this study was to quantify trends in CRC treatment complexity associated with chemotherapy, a primary modality for CRC treatment. Methods: Electronic medical records for patients with stage I-IV CRC referred between 2000 to 2012 to the six oncology centers comprising the British Columbia Cancer Agency were included in this study. Trends in treatment complexity were evaluated following a phase of care approach, which stratified all analyses by five phases: I and II (first six months of adjuvant and continued adjuvant therapy), III and IV (first six months of palliative and continued palliative therapy), and V (last six months of life). Colon and rectal patients were evaluated separately due to differences in treatment. Treatment complexity was measured using 12 metrics: count and frequency of clinic visits, chemotherapy infusion treatment (CIT) visits, and chemotherapy prescriptions, as well as mean duration, total duration, and total duration per year of visits. Metrics describing count and frequency were modelled using quasi-Poisson regression models, while metrics describing duration were modelled using generalized linear regression models with Gamma distribution and log-link. A total of 120 regression models were used to evaluate trends of CRC treatment complexity. Results: A total of 14,759 patients were included in the final analyses. Counts and frequencies of clinic visits increased in all phases for rectal cancer patients, and for all phases except phase V for colon cancer patients; CIT visits increased in phase II-V among colon and rectal cancer patients but decreased in phase I; prescriptions in phases II-IV in both tumor sites increased but did not change in phases I and V. Significantly longer visits were found in 57 of 60 visit duration models; no change was found only in total duration of clinic visits per year among rectal cancer patients in phases II-IV. Conclusions: CRC patients initiating a phase of care in 2012 received significantly more complex treatment than patients initiating in 2000, which may have had significant implications for resource allocation and patient experience.

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2019-02-06

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/68328

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/