The association between usual health care utilization and stage at diagnosis in laryngeal cancer

Abstract

Background: A significant number of laryngeal cancer patients are diagnosed with advanced-stage disease. Since stage at diagnosis is an important prognostic factor, it is necessary to understand the characteristics of individuals at risk of being diagnosed at an advanced stage. Objectives: (1) Compare usual health care utilization between laryngeal cancer patients and the general population. (2) Evaluate the association between usual health care utilization and stage at diagnosis in laryngeal cancer. Methods: The study population included 1,702 laryngeal cancer patients diagnosed from 2005–2008, and 8,510 matched-controls from the general population. Demographic, clinical, and health administrative data from Ontario were used to measure usual health care utilization in a two-year period (i.e. frequency of encounters, continuity of care, primary care model enrolment, and preventive services use), stage at diagnosis, and covariates. Results: Laryngeal cancer patients had fewer health care encounters and a greater propensity for using preventive services than the general population. Comparisons of usual health care utilization among laryngeal cancer patients showed significant trends across Stage I–IV for the frequency of encounters (p=0.002), continuity of care (p=0.02), and preventive services use (p<0.0001). Stage I patients were less likely than Stage II–IV patients to have a low frequency of encounters (10%), low continuity of care (28%), and no preventive services use (28%). In adjusted multivariable analyses, low continuity of care was marginally associated with an increased risk of advanced-stage laryngeal cancer (RR [95% CI]: 1.17 [1.01, 1.34]). Stratification by subsite showed a marginally significant association between continuity of care and stage in glottic cancer (RR [95% CI]: 1.25 [0.98, 1.58]), but no association in supraglottic cancer (RR [95% CI]: 1.01 [0.89, 1.15]). Conclusions: Laryngeal cancer patients’ patterns of usual health care utilization differ from the general population. There was little evidence of an effect of usual health care use on the risk of advanced-stage laryngeal cancer in multivariable analyses adjusting for confounders. Multinomial regression may be needed to fully elucidate the effects of health care utilization across Stage I–IV. Understanding health care utilization among laryngeal cancer patients is important for improving early detection and warrants further research.