Comorbidities, Rather Than Older Age, Are Strongly Associated With Higher Utilization of Healthcare in Colorectal Cancer Survivors

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  • 1 Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg;
  • | 2 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg;
  • | 3 SLK-Clinics, Cancer Center Heilbronn-Franken, Heilbronn;
  • | 4 Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg;
  • | 5 Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg;
  • | 6 Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg; and
  • | 7 German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.

Background: Colorectal cancer (CRC) survivors generally have a higher healthcare utilization (HCU) than the general population due to cancer burden. However, it is unclear which factors are associated with this increased uptake. Our study aimed to (1) compare CRC-related and non-CRC visits to general practitioners (GPs) and medical specialists (MSs) by comorbidities, and (2) assess whether HCU differs by demographic, clinical, and psychological factors. Methods: We used data from a German population-based cohort of 1,718 survivors of stage I–III CRC diagnosed in 2003 through 2010 who provided information on HCU at 5-year follow-up. Multivariable linear regression was used to calculate least-square means of CRC-related and non-CRC HCU according to the Charlson comorbidity index and comorbidity cluster, adjusting for relevant demographic, clinical, and psychological characteristics. Results: A higher comorbidity level was associated with more CRC-related MS visits and non-CRC GP visits. In addition to being strongly associated with non-CRC GP visits, comorbidity clusters were associated with CRC-related GP and MS visits, but their association varied by specific cardiometabolic comorbidities. HCU was less dependent on prognostic factors for CRC, such as age and tumor stage, but was strongly associated with disease recurrence, depression, and emotional functioning. Conclusions: Comorbidities, rather than age or tumor stage, were related to HCU, suggesting that CRC survivors use healthcare mainly for reasons other than cancer 5 years postdiagnosis. Improved communication between primary and tertiary healthcare providers could enhance the medical care of cancer survivors with complex health needs and thereby also reduce healthcare costs.

Submitted July 17, 2020; final revision received February 1, 2021; accepted for publication February 17, 2021. Published online December 7, 2021.

Author contributions: Study concept: Thong, Boakye, Arndt. Conceptualization of DACHS and IMPACT studies: Chang-Claude, Hoffmeister, Brenner. Data curation: Jansen. Formal analysis: Thong, Boakye. Funding acquisition: Chang-Claude, Hoffmeister, Brenner, Arndt. Writing—original draft: Thong. Writing—review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by the German Research Council (BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, BR 1704/6-6, CH 117/1-1) and the German Federal Ministry of Education and Research (01KH0404, 01ER0814, 01ER0815).

Disclaimer: The funding source was neither involved in the collection, interpretation, and analysis of the data nor in the decision for the writing and submission of this report for publication.

Correspondence: Melissa S.Y. Thong, PhD, Unit of Cancer Survivorship (C071), Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), P.O. Box 101949, 69009 Heidelberg, Germany. Email: m.thong@dkfz.de

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