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Fragmentation of care and colorectal cancer survival in South Korea: comparisons according to treatment at multiple hospitals

  • Original Article – Cancer Research
  • Published:
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Abstract

Purpose

Fragmented cancer care (FC) means that patients visit multiple providers for treatment, which is common in cancer care. While FC is associated with poor health outcomes in patients with colorectal cancer (CRC) worldwide, there is still a lack of evidence in South Korea. We investigated the association between FC and 5-year morality in patients with CRC using population-based claims data.

Methods

The study population was followed up from 2002 to 2015. Data were collected from Korea National Health Insurance claims. Participants comprised patients with CRC diagnosed with International Classification of Diseases (ICD)-10 (C18.x–C20.x) and a special claim code for cancer (V193). Data were analyzed using the Kaplan–Meier curve with a log-rank test and Cox proportional hazard model. The effect of FC on patients’ 5-year survival was examined.

Results

Of 3467 patients with CRC, 20.0% had experienced FC. FC was significantly associated with an increased risk of 5-year mortality (hazard ratio 1.516, 95% confidence interval 1.274–1.804). FC was prevalent in those who had a low income level, underwent chemotherapy, did not undergo radiation therapy, and did not visit a tertiary hospital for their first treatment.

Conclusion

Efforts to decrease FC and integrate complex cancer care within appropriate healthcare delivery systems may improve survivorship among patients with CRC.

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Data availability

Data for this study are public data and can be obtained from the following NHIS website after completing the application form and fee payment: https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do.

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Funding

This work was supported by the National Cancer Center (no. NCC 2111070-2). The funding sources did not play a role in study design or data interpretation.

Author information

Authors and Affiliations

  1. Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, 10408, Republic of Korea

    Dong-Woo Choi

  2. Department of Nursing, College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Seungju Kim

  3. Department of Information and Statistics. RINS, Gyeongsang National University, 501, Jinju-daero, Jinju, Gyeongsangnam-do, 52828, Republic of Korea

    Dong Wook Kim

  4. Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea

    Kyu-Tae Han

Authors
  1. Dong-Woo Choi
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Contributions

DWC and KTH led the design and conception of the study and wrote the manuscript. DWK performed the data analysis. SJK contributed to the discussion and reviewed and edited the manuscript. All the authors have read and approved the final manuscript.

Corresponding author

Correspondence to Kyu-Tae Han.

Ethics declarations

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study utilized secondary data, and all patients’ personal data were encrypted and anonymized. A waiver from the Institutional Review Board of the International Review Board, Korean National Cancer Center (no. NCC2021-0060) was obtained. All methods were performed in accordance with relevant guidelines and regulations.

Consent to participate

A waiver for informed consent was also approved by the International Review Board of the Korean National Cancer Center.

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Not applicable.

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Choi, DW., Kim, S., Kim, D.W. et al. Fragmentation of care and colorectal cancer survival in South Korea: comparisons according to treatment at multiple hospitals. J Cancer Res Clin Oncol 148, 2323–2333 (2022). https://doi.org/10.1007/s00432-022-04035-9

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  • DOI: https://doi.org/10.1007/s00432-022-04035-9

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