Use of Oncology Specialty Care Associated With GI Symptoms in Survivors of Colon Cancer

Oncologic specialty care was more often used in colon cancer survivors who have persistent symptoms of gastrointestinal (GI) problems, according to a study published in the International Journal of Colorectal Disease.¹ Health care utilization could be decreased by identifying and managing symptoms earlier.

Survivors of cancer number approximately 18 million in the US as of 2022.² Thus, cost of management of cancer survivors is expected to increase. Colorectal cancer (CRC) is one of the more prevalent cancers that affect patients, leading to a great number of survivors in the US, estimated at more than 1.4 million patients. GI symptoms are common in patients with a prior diagnosis of CRC. This study aimed to establish the relationship between health care utilization in patients who have survived CRC and their self-reported GI symptoms.

All participants—adults who were treated surgically for stages I to IV colon cancer—were enrolled in the Lifestyle and Outcomes after Gastrointestinal Cancer study between February 2017 and June 2022, which consisted of patients who had received care at the University of California, San Francisco (UCSF) and had a prior diagnosis of a GI cancer. The present study used only the data on patients with colon cancer.

Colon cancer survivors were more likely to use health care services to address their GI symptoms | Image credit: mi_viri - stock.adobe.com

Demographic, social, health behaviors, and quality of life (QOL) data were collected from the participants through a self-reported online questionnaire: the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-CR29) and QLQ-C30. Tumor, clinical, and surgical characteristics were all obtained through the patient’s electronic medical record. Participants were excluded if they did not have any QOL information, had surgery for colon cancer more than 10 years prior to their enrollment, or did not receive care at UCSF.

Any service utilization within the 3 outpatient clinics that were part of UCSF and specialized in colon cancer care were outcomes of interest. The primary outcome of the study was number of clinical visits within the first 6 months after the survey was taken. Visits were only included if it they were with a licensed medical professional. Number of telephone encounters with clinical personnel was the secondary outcome.

There were 126 patients included in the study, of whom 56% were women. The mean age of the participants was 59 years, and they completed a QOL survey a median (range) of 4 (1-11) times.

The average number of clinic visits, telephone encounters, and patient-initiated messages within the first 6 months after symptoms was 1.2, 0.5, and 3.2, respectively. Patients had significantly more clinic visits in the 6 months after reporting symptoms if they had abdominal pain (risk ratio [RR], 1.45; 95% CI, 1.15-1.83), buttock pain (RR, 1.30; 95% CI, 1.00-1.68), and increased stool frequency (RR, 1.26; 95% CI, 1.01-1.59). Clinic visits did not differ in patients with other symptoms.

Patients with at least 1 of these symptoms had 38% more clinic visits (RR, 1.38; 95% CI, 1.09-1.73). A patient who had only 1 of these symptoms had 25% more clinic visits (RR, 1.25; 95% CI, 0.98-1.60) and patients with 2 of these symptoms had 71% more clinic visits (RR, 1.71; 95% CI, 1.26-2.30) compared with patients who had not reported any symptoms. Abdominal pain proved to be the only covariate that was independently associated with clinic visits, with patients with abdominal pain having 36% more clinical visits (RR, 1.36; 95% CI, 1.06-1.74) compared with patients who reported no symptoms.

Clinical telephone encounters were more frequent in patients with blood or mucus in their stool (RR, 2.46; 95% CI, 1.26-4.84). Patient-initiated messages were more frequent in patients with abdominal pain compared with those without abdominal pain (RR, 1.65; 95% CI, 1.20-2.27).

There were some limitations to this study. Generalizability is limited due to the single-center design of the study, and care received outside of the clinics was not taken into account, which could limit the results. All participants had surgery recently, which could result in different findings compared with patients who had their surgery less recently, and outcomes were nonemergent outpatient services, which may exclude visits to the emergency department. Further, the volume of visits, phone calls, and secure messages acted as the outcome variables without the investigators knowing the content of the encounter, which could mean some of the encounters were not related to a specific GI symptom, and more than 80% of the participants had at least an undergraduate degree even when the analysis found there wasn’t an association found between education and utilization.

Oncologic specialty care was used more frequently in patients with GI symptoms who had surgery for colon cancer within the past 6 months. The authors recommend counseling survivors of colon cancer to prepare them for these symptoms and to improve their patient education. This could help in avoiding overuse of services to address these symptoms in the future.

References

1. Edwards AL, Trang K, Tolstykh IV, et al. Association between gastrointestinal symptoms and specialty care utilization among colon cancer survivors: a cohort study. Int J Colorectal Dis. 2024;39(1):130. doi:10.10.1007/s00384-024-04685-w
2. Cancer statistics. National Cancer Institute. Updated May 9, 2024. Accessed August 14, 2024. https://www.cancer.gov/about-cancer/understanding/statistics