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Older survivors of gynecologic and other cancers spent a total of nearly 1 month a year -- so-called healthcare contact days -- receiving healthcare outside the home, researchers reported. Most of such care was ambulatory, often delivered by non-oncologists, and affected by various factors beyond clinical characteristics.

Healthcare contact days represent an intuitive, practical, and patient-centered measure to understand how much of a patient's time is consumed by both inpatient and ambulatory interactions with the healthcare system, explained Arjun Gupta, MD, of the University of Minnesota in Minneapolis, and colleagues. Previous studies, the team noted in their analysis in , showed that patients with aggressive advanced/metastatic cancer can spend a fourth of their days with healthcare contact, but no study to date had examined contact days among longer-term cancer survivors.

In the following interview, co-author Ishani Ganguli, MD, MPH, of Brigham and Women's Hospital in Boston, discussed the study, which included a nationally representative sample of older adult cancer survivors.

What does the study add to the literature?

Ganguli: This study offers first-time national estimates of healthcare contact days, a marker for the potential burdens of healthcare for older adults with cancer. We linked 2019 Medicare Current Beneficiary Survey and traditional Medicare claims data for community-dwelling older adults with a history of cancer. We identified contact days -- that is, days spent in a hospital, emergency department, skilled nursing facility, or inpatient hospice, or receiving ambulatory care including an office visit, procedure, treatment, imaging, or test -- and described the patterns of total and ambulatory contact days.

The study uses a national sample of older adults in traditional Medicare who have had cancer, and shows that these adults spent an average of 4 weeks -- 28 days -- a year getting healthcare outside of the home. Most of these days were spent on ambulatory care like doctor's visits, tests, imaging, and treatments. Most tests, imaging studies, procedures, and treatments were not on the same day as an office visit, which implies that doctors may be missing opportunities to coordinate care for patients better.

We included 1,168 older adults representing 4.51 million cancer survivors -- median age 76.4 years, 52.8% women. The median time from cancer diagnosis was 65 months. In 2019, these adults had mean total contact days of 28.4 days and ambulatory contact days of 24.2. These included days for tests (8), imaging (3.6), visits with any clinicians (12.4), and visits with primary care clinicians (4.4), and non-oncology specialists (7.1) specifically.

About two-thirds (64%) of days with a non-visit ambulatory service -- for example, a test -- were not on the same day as a clinician visit. Factors associated with more total contact days included younger age, lower income, more chronic conditions, poor self-rated health, and tendency to "go to doctor as soon as feel bad."

What are the implications specifically for endometrial cancer patients?

Ganguli: We did not look at endometrial cancer patients specifically, but the above applies to these patients as well. In the current study only 5.6% of cancer survivors had endometrial or another gynecological cancer.

Our lead author, Arjun Gupta, MD, of the University of Minnesota, notes that another study on contact days/time toxicity in patients with gynecological cancers was presented at the 2023 Surgical Gynecological Oncology annual meeting on Women's Cancer. Results showed that patients with advanced recurrent endometrial cancer spent 15% of their time on treatment engaging with healthcare.

A study led by Gupta on patients with reported an approximately 25% rate, and other work in people with .

Broadly, we are finding that for people with active, stage 4 advanced cancer actively receiving cancer treatment, 15-25% of days are contact days, whereas for longer-term cancer survivors who have perhaps completed active cancer treatment (the focus of the current paper), it is more like 1 month in a year (8% or so), and these data likely apply to gynecological cancer survivors, too.

What are the specific burdens faced by certain populations?

Ganguli: Patients had more contact days if they were younger, had lower incomes, had more chronic conditions, were in poorer health by their own judgment, and reported that they had a tendency to go to the doctor as soon as they felt bad.

Our finding that ambulatory services like tests and imaging studies were not on the same day as office visits tells us that we may be able, for example, to find ways to combine tests with a visit more often to reduce the number of trips patients make to the clinic or hospital.

What is your main message for practicing oncologists?

Ganguli: Practicing oncologists can take away how burdensome care can be for cancer survivors, even those who are not undergoing active cancer treatments. As we note in our paper: "These results suggest ways to improve survivorship care -- for example, through better care coordination and navigation in clinical practice; proactively addressing psychosocial care preferences; and building, training, and uniting a diverse cancer survivorship workforce."

The results highlight the need to recognize patient burdens and improve survivorship care delivery, including through care coordination.

Read the study here and expert commentary about it here.