Quality Improvement
Dhruvin H. Hirpara, MD MSc
Chief Resident
University of Toronto
Etobicoke, Ontario, Canada
Disclosure: Disclosure information not submitted.
Value of care is defined as patient-relevant outcomes achieved per dollar spent. Patient Reported Outcomes (PROs) offer a unique lens into cancer care; their relationship with cost and resource utilization, however, is yet to be defined. We examined the association between PROs and health resource utilization (HRU) in the year after cancer diagnosis, with a view to develop PRO-based measures of Value.
Methods: We conducted a population-based cohort study of adults with cancer (2008-2019). The exposure was symptom burden measured using Edmonton Symptom Assessment System (ESAS) scores. The outcome was total healthcare cost within 30-days of ESAS reporting, as a metric for HRU. HRU was further stratified into cancer-directed therapies (i.e., chemotherapy and radiation) or ancillary services including emergency department visits, complex continuing care, homecare, and inpatient mental health. Linear regression models with log-transformed costs examined the association between ESAS scores and outcomes adjusting for potential confounders.
Results:
1,728,025 ESAS surveys from 285,924 patients were analyzed. Gastrointestinal, breast and CNS cancers were the most resource intensive cancers with median 30-day costs after ESAS of $85,000, $81,000, and $78,000, respectively. Each 10-point increase in total ESAS score (0 to 90) was associated with a 9.4% decrease in the cost of cancer-directed therapies (HR 0.906, 95%CI 0.901–0.911). Conversely, each 10-point increase was associated with an 18% increase in costs of ancillary care (HR 1.184, 95%CI 1.181–1.186). Figure 1 shows symptom specific hazard ratios.
Conclusions:
High symptom burden was associated with decreased use of cancer-directed therapy but increased use of ancillary care, indicating treatment interruptions with potential impacts on oncologic outcomes. Proactive symptom management may mitigate unnecessary HRU and facilitate cancer-directed therapies. Future work will further explore the relationship between PROs and HRU/costs to develop a PRO-based measure of Value in cancer care.