GPP12: Association Between Patient-Reported Symptoms and Healthcare Resource Utilization: A First Step to Develop Patient-Centered Value Measures in Cancer Care
Surgical Oncology Fellow University of Toronto Etobicoke, Ontario, Canada
Purpose: Value of care is defined as patient-relevant outcomes achieved per dollar spent. There remains a need to include objective measures of patient experience in determining value. We examined the association between patient-reported outcomes (PROs) and health resource utilization (HRU) in the year after cancer diagnosis, with a view to develop PRO-based measures of value in cancer care.
Methods: We conducted a population-based cohort study of all adults with cancer, in the province of Ontario, Canada between 2008 to 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., chemoradiotherapy) or ancillary health services including emergency department visits, home care, and complex continuing care to study the variable association of symptom burden on the type of resources utilized. Linear regression models with log-transformed costs, clustered at the patient level, were used for analysis.
Results: 1,728,025 ESAS surveys from 285,924 patients were analyzed. 47% of the patient cohort was comprised of patients with stage I-II disease. Tiredness, depression, and poor well-being were the top three symptoms reported by patients, across all disease sites. Patients with respiratory and head and neck tumors carried the greatest burden of moderate to severe symptoms (ESAS score ≥4) in the year following diagnosis. Gastrointestinal, Breast and CNS were the most resource intensive cancers with median 30-day costs after ESAS of $85,000, $81,000, and $78,000, per patient, respectively. Each 10-point increase in total ESAS score was associated with a 9.4% decrease in the cost of cancer-directed therapies including chemotherapy and radiotherapy. Conversely, each 10-point increase in total ESAS score was associated with an 18% increase in costs of ancillary health care resources.
Conclusion: High symptom burden was associated with decreased use of cancer-directed therapy but increased use of ancillary healthcare resources. Proactive symptom management may facilitate cancer care while mitigating unnecessary healthcare utilization and low value-added care.