Healthcare Utilization Associated with Management of Oral and Oropharyngeal Cancer in Alberta: Trends and Predictors
Creators: Mirimoghaddam, Masoud
Publisher: name: University of Alberta Library
Year: 2023

<p>Background: The increasing incidence of oral cavity cancer (OCC) and oropharyngeal cancer<br>
(OPC), especially HPV-related OPC, is a concerning healthcare challenge. Statistics Canada&#39;s<br>
recent report indicates a substantial 13.9% increase in OPC incidence in 2020 compared to the<br>
average from 2015-2019. Managing these cancers is resource-intensive and complex, and<br>
patients often endure not only the challenges of cancer itself but also treatment complications,<br>
especially when diagnoses occur in late stages.<br>
Effective and timely management of treatment complications is crucial, as improper<br>
handling can lead to acute care needs and treatment interruptions, such as emergency department<br>
(ED) visits and unplanned hospitalizations (UH), which have been associated with poorer<br>
oncologic outcomes. Considering the rising incidence and prevalence of these cancers, it<br>
becomes crucial to assess the healthcare utilization associated with delivering high-quality care<br>
for patients. Understanding and evaluating the patterns of healthcare utilization can provide<br>
valuable insights to enhance patient care, optimize resource allocation, and improve overall<br>
treatment outcomes.</p>

<p>Objectives: With this background, this study had three main objectives: 1) Investigate trends in<br>
hospitalization and visits of OCC and OPC patients in emergency department, outpatient clinic,<br>
and community offices 2) Identify predictors of acute care visits, including unplanned<br>
hospitalizations, 30-day hospital readmissions, and emergency department visits 3) Determine<br>
the primary diagnoses of patients admitted to hospitals, visited emergency departments, and<br>
outpatient clinics.</p>

<p>3<br>
Methods: This retrospective, population-based cohort study utilized administrative data<br>
collected from all healthcare facilities in Alberta from 2010 to 2019. The study cohort consisted<br>
of adult patients (18 years old or older) diagnosed with a primary tumor of the OCC or OPC,<br>
identified through the Alberta Cancer Registry (ACR). To examine the cohort&#39;s healthcare<br>
utilization, the ACR cohort was linked with the Discharge Abstract database, National<br>
Ambulatory Care Reporting System, and Physician Claim dataset. The primary diagnosis of<br>
patients in each event was determined using diagnosis codes from each database. For data<br>
analysis, the study outcomes were assessed using statistical methods, including logistic and<br>
linear regression, as well as parametric and non-parametric tests, all conducted using SAS<br>
Enterprise Guide 7.1.</p>

<p>Results: The final cohort consisted of 1,721 patients, 72.4% were male and 57.9% were between<br>
45-65 years of age. OPC patients were diagnosed at a significantly younger age, with a mean age<br>
of 59.4 years, compared to OCC patients who had a mean age of 62.4 years (P-value &lt; 0.05).<br>
During the study, 34% (582 individuals) of the patients had at least one visit to the ED, and 72%<br>
(1,244 patients) had at least one hospitalization visit. UHs constituted 48.1% of the overall 2,228<br>
hospitalizations. Notably, outpatient clinic and community office visits showed a significant<br>
increase during the study period, with visits rising from 475 to 1,101 (β=0.20, P=0.01) and from<br>
1,653 to 2,629 (β=0.31, P=0.02), respectively. Concurrently, ED visits decreased from 0.65 to<br>
0.49 visits per patient, and the rate of UHs per patient decreased from 0.69 to 0.54 visits.</p>

<p>The common diagnosis for UHs were palliative care and post-surgical recovery, while<br>
surgery-related complications were frequent causes of 30-day unplanned readmissions. In ED</p>

<p>4<br>
visits diagnoses of dehydration, post-procedural infections, and nausea and vomiting were<br>
frequent. Predictors of UHs included cancer stage, material deprivation, and the chosen treatment<br>
modality, whereas cancer type and comorbidities emerged as key predictors for readmissions.<br>
Moreover, Predictors of ED visits included cancer stage, rural residence, high material<br>
deprivation scores, and treatments other than surgery or no treatment.</p>

<p>Conclusion: The study&#39;s findings revealed a decrease in ED visits and UHs among cancer<br>
patients diagnosed between 2010 and 2017, accompanied by increased utilization of outpatient<br>
clinics and community offices, indicating a shift towards primary care settings for cancer-related<br>
care. Implementing a primary care model may have contributed to better patient management,<br>
reducing acute care visits and hospitalizations. Predictors of acute care events highlighted the<br>
importance of improving access to care for underprivileged patients and those in rural areas. It<br>
also showed Patients not receiving oncologic treatments and those undergoing radiation therapy<br>
need for close monitoring and intervention. Preventive strategies and patient education could<br>
help reduce avoidable ED visits, while monitoring and managing procedure-related complications can prevent subsequent hospital events.</p>