A Population-Based Study of Healthcare Resource Utilization by Metastatic Gastric Cancer Patients in Ontario

Abstract

Background: Gastric cancer is the fourth most common cancer in the world. Non-curative, metastatic disease is frequent in low incidence countries; management strategies for relief of symptoms include surgery, chemotherapy and radiotherapy. The resource utilization of metastatic gastric cancer patients is unstudied in the Canadian system, and predictors of major cost drivers and end-of-life care unknown. Our purpose was to describe the resource utilization of metastatic gastric cancer patients in Ontario, compare resource utilization among Local Health Integration Networks (LHINs) and examine predictors of inpatient hospital days and receipt of homecare. Methods: This is a retrospective cohort study of metastatic gastric adenocarcinoma patients registered in the Ontario Cancer Registry between April 1, 2005 and March 31st, 2008. Chart review and administrative healthcare data were linked to describe non-therapeutic endoscopic, radiologic and surgical investigations and treatment strategies from the healthcare system perspective, using a two-year and two month time horizon. Chi square tests were used to compare proportions of resource utilization, and non-parametric one-way ANOVA compared mean per patient usage. Negative binomial regression was used to model the number of inpatient hospital days. Modified Poisson regression was used to model receipt of homecare. Results: The cohort consisted of 1433 patients with metastatic disease. Less than half of the patients received chemotherapy (43%), gastrectomy (37%) or radiotherapy (28%). Geographic variation existed in the type of health services consumed and in the frequency of their use among LHINs. Location of the primary tumour, resource utilization band, receipt of a gastrectomy and care from a high volume physician were independent predictors of inpatient hospital days. Home care use was predicted by location of the primary tumour, receipt of care from a high volume physician and the number of days survived within the study period. Conclusion: Variation in healthcare resource utilization exists between LHINs in Ontario for the care of metastatic gastric cancer patients. Whether these differences reflect differential access to iii resources, patient preference or physician preference is not known. Further research needs to examine differences and how they impact on clinical disease outcomes. Next steps include incorporating predictors of resource utilization measures into clinical and policy-level decision-making.