Introduction: Patients with colorectal cancer (CRC) are susceptible to experiencing fragmentation of healthcare as they require complex treatments with multidisciplinary teams. Health systems of low-middle income countries have high fragmentation of care, making CCR patients prone to poor clinical outcomes. We aimed to identify the impact fragmentation of healthcare had on 5-year overall survival of patients treated for colorectal cancer in Colombia.

Methods: We conducted a retrospective cohort study based on administrative claims provided by the Colombian Ministry of Health. Patients who had their first CRC ICE-10 codes in 2013 and who met a previously validated CRC case algorithm combining oncologic procedures and ICE-10 codes were included. Exposure to fragmentation was defined as the number of different providers visited per year per patient. The outcome was overall 5-year survival. Firstly, we conducted a piecewise linear regression to set a fragmentation cut-off and dichotomize the exposure. Lastly, we used propensity score matching (PSM) to balance baseline covariates and estimated hazard ratios (HR) with a Cox regression with the matched sample to compare patients more or less exposed to fragmentation. Robust standard errors were used. Funding: Colombian Ministry of Science.

Results: 1678 patients were included. 837 (49.88%) were men. Mean age was 63.05 (SD 14.32). Fragmentation mean was 6.91(SD 7.80) providers per year. Patients exposed to more fragmentation were who visited more than 9.82 providers per year (fragmentation cut-off). 309(18.41%) were more exposed to fragmentation. Mortality rate were 148.18(IC95% 132.50-165.72) and 11.44(IC95% 10.56-12.40) per 100 person-year for more and less exposed, respectively. Median survival time was 4.14. HR before PSM was 23.82 (CI95% 19.57-29.00), HR after PSM was 13.78 (CI95% 10.61-17.89).

Conclusion: Healthcare fragmentation in patients treated for CRC in Colombia is associated with a reduced survival. Administrative claims are a source where fragmentation of cancer healthcare can be estimated.