Healthcare contact days for patients with stage IV non-small cell lung cancer (NSCLC) in Ontario: A population-based study.
Notice bibliographique
Résumé
484 Background: For people with advanced NSCLC, visits to healthcare facilities can impose time burdens and take over patients’ lives, especially in the context of limited survival. It is unclear if time burdens vary based on use and type of systemic therapy. We sought to describe patterns of contact days— days with any in-person healthcare contact as a measure of potential time toxicity—in a population-based sample. Methods: We created a population-based, retrospective decedent cohort with health administrative data covering the population of Ontario, Canada (15 million), of adults aged ≥20 years diagnosed with stage IV NSCLC in 2014-2017 and died in 2014-2019. We stratified analysis by systemic therapy received (yes vs no), type of systemic therapy: chemotherapy, immunotherapy, or targeted therapy, and lines received (one, two). The primary outcome was contact days measured from diagnosis to death. We calculated percentage contact days as contact days divided by overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified 5,785 stage IV NSCLC patients (median age, 70 years, 46.3% female, 57.8% adenocarcinoma, 34.3% received systemic therapy). The median (IQR) survival was 108 days (49-426) and median percentage of contact days 33.3%. Median [IQR] overall survival was longer in patients who received systemic therapy vs. not (261 [152-420] days, vs. 66 [34-130] days). The median percentage of contact days was lower in those who received systemic therapy vs. not (22.2% vs. 40.9%). Overall and for subgroups (systemic therapy vs no, type of therapy, receiving one or two lines), normalized trajectories followed a U-shaped distribution, with highest rates immediately following diagnosis, and prior to death, with a lower middle-phase. The difference between the maximal peak and trough was greater in patients who received systemic therapy (peak 34.8% vs trough 15.9%, ‘’deeper U’’) vs. not (39.5% vs 27.6%, ‘’shallower U’’). The trough was slightly lower for targeted therapy (12.3%, vs 15.9% immunotherapy, vs. 17.7% chemotherapy). Conclusions: Patients with stage IV NSCLC spent a significant proportion of days alive with health care contact, with higher contact days immediately post-diagnosis and pre-death (U-shaped curve). Among those not receiving systemic therapy, the high percentage of contact days, short survival, and shallower U-shaped trajectory reflect their poor underlying health and steady need for supportive care. With systemic therapy, those receiving targeted therapy experienced slightly fewer contact days at the trough of their U-shaped trajectory. These data serve as a call to recognize patient time toxicity, improve care delivery efficiency, and better support patients during periods of high burden.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».