LONGITUDINAL ASSOCIATIONS OF CHEMOTHERAPY INDUCED SYMPTOM CLUSTERS WITH HEALTHCARE UTILIZATION AND MORTALITY AMONG PATIENTS WITH GASTROINTESTINAL CANCERS
Author(s)
Chengbo Zeng, PhD1, Nneka Ufere, MD2, Patricia Dykes, PhD1, Yu-Jen Chen, MPH1, Shumenghui Zhai, PhD3, Maria Edelen, PhD1, Jason Liu, MD4, Kelsey Lau-Min, MD2, Kelly Kenzik, PhD1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3Pacific Lutheran University, Tacoma, WA, USA, 4The University of Texas MD Anderson Cancer Center, Boston, MA, USA.
1Brigham and Women's Hospital, Boston, MA, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3Pacific Lutheran University, Tacoma, WA, USA, 4The University of Texas MD Anderson Cancer Center, Boston, MA, USA.
OBJECTIVES: This study aims to analyze the longitudinal associations of chemotherapy (CTX) induced neurological and gastrointestinal (GI) symptoms with healthcare utilization and mortality.
METHODS: We conducted a retrospective study of 973 GI cancer patients in the Mass General Brigham Health System from 2019 to 2024. The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events was used to assess 12 CTX-related symptoms at initiation and at days 30, 60, and 90 post initiation. Primary outcomes were all-cause urgent care visits, emergency department (ED) visits, and death within one year of CTX. Neurological cluster was defined as the co-occurrence of fatigue, insomnia, paresthesia, or pain. GI cluster was defined as the co-occurrence of constipation, decreased appetite, diarrhea, nausea, or vomiting. Time-to-event analysis was used to predict each outcome based on changes in neurological and GI clusters over the first 90 days of CTX. We also examined whether findings varied by age group, comorbidity level, time since diagnosis, cancer stage, and type.
RESULTS: Over time, the burden of neurological symptoms was significantly higher than that of GI symptoms. Higher neurological burden was associated with an increased risk of urgent care visits (Adjusted HR: 1.27 [95% CI: 0.97-1.67]), but not ED visits or death, with stronger associations among older adults and those without comorbidities. In contrast, higher GI burden was associated with greater risks of ED visits (Adjusted HR: 1.10 [95% CI: 1.02-1.19]) and death (Adjusted HR: 1.08 [95% CI: 0.94-1.24]), but not urgent care visits, with stronger effects among older adults, patients with comorbidities, and those with advanced cancers.
CONCLUSIONS: Short-term changes in neurological and GI clusters exhibited differential associations with long-term healthcare utilization and mortality. Early management of these clusters has the potential to reduce healthcare utilization and the relevant costs.
METHODS: We conducted a retrospective study of 973 GI cancer patients in the Mass General Brigham Health System from 2019 to 2024. The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events was used to assess 12 CTX-related symptoms at initiation and at days 30, 60, and 90 post initiation. Primary outcomes were all-cause urgent care visits, emergency department (ED) visits, and death within one year of CTX. Neurological cluster was defined as the co-occurrence of fatigue, insomnia, paresthesia, or pain. GI cluster was defined as the co-occurrence of constipation, decreased appetite, diarrhea, nausea, or vomiting. Time-to-event analysis was used to predict each outcome based on changes in neurological and GI clusters over the first 90 days of CTX. We also examined whether findings varied by age group, comorbidity level, time since diagnosis, cancer stage, and type.
RESULTS: Over time, the burden of neurological symptoms was significantly higher than that of GI symptoms. Higher neurological burden was associated with an increased risk of urgent care visits (Adjusted HR: 1.27 [95% CI: 0.97-1.67]), but not ED visits or death, with stronger associations among older adults and those without comorbidities. In contrast, higher GI burden was associated with greater risks of ED visits (Adjusted HR: 1.10 [95% CI: 1.02-1.19]) and death (Adjusted HR: 1.08 [95% CI: 0.94-1.24]), but not urgent care visits, with stronger effects among older adults, patients with comorbidities, and those with advanced cancers.
CONCLUSIONS: Short-term changes in neurological and GI clusters exhibited differential associations with long-term healthcare utilization and mortality. Early management of these clusters has the potential to reduce healthcare utilization and the relevant costs.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR180
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Oncology