Could higher hospital spending improve survival in patients with esophageal squamous cell carcinoma? A multicenter retrospective cohort study

TL;DR

This study explores whether higher hospital spending improves survival in esophageal cancer patients, finding mixed results depending on cancer stage.

Contribution

The study reveals that higher hospital spending is linked to worse survival in early-stage but better survival in advanced-stage esophageal squamous cell carcinoma.

Findings

Higher spending was associated with worse overall survival in early-stage (stage 0-II) ESCC patients.

Higher spending was associated with better overall survival in advanced-stage (stage III-IV) ESCC patients.

The observed associations were consistent across two different hospital centers.

Abstract

The hospital spending of patients with esophageal squamous cell carcinoma (ESCC) have been increasing over years, imposing a heavy economic burden on these patients. However, little is known about the association between spending and their overall survival (OS).

We recruited 11,037 ESCC patients who were admitted between August, 2009 and December, 2018 at the Southern Center (Cancer Hospital of Shantou University Medical College), and between January, 2012 to December, 2017 at the Northern Center (Anyang Cancer Hospital). Spending terciles were the exposure measure, and OS was the outcome. OS in terciles 2 and 3 was compared with OS in tercile 1 (the lowest spending tercile) using Cox regression models. Analyses were stratified by TNM stage and study center.

Monthly hospital spending followed an “L-shaped” trend. After a maximum follow-up of 12.52 years, the median survival time was 4.70 years. Higher spending was associated with worse OS in stage 0-II patients (adjusted HRtercile 3 vs 1 = 1.55, 95% CI: 1.27-1.89), but with better OS in stage III-IV patients (adjusted HRtercile 2 vs 1 = 0.82, 95% CI: 0.74-0.90; adjusted HRtercile 3 vs 1 = 0.73, 95% CI: 0.64-0.83). These associations were consistent across both the Southern and Northern Centers.

The findings suggest that early-stage ESCC patients may benefit from more conservative treatment approaches, whereas advanced-stage patients require comprehensive and sufficient treatment.

Methods and results of a study on hospital spending and survival in esophageal squamous cell carcinoma. Methods involved 11,037 patients from Southern and Northern Centers over 12.52 years. Results indicate an L-shaped spending trend: higher spending worsens early-stage survival but improves advanced-stage survival. Conclusions suggest oncology training and insurance improvements. Study by Lei Chen et al. in Frontiers in Oncology.

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