3552 - Utilization Rates of Local Hemostatic Treatments for Gastric Cancer: A Survey Based on a Nationwide Claims Database
Presenter(s)
Y. Wada1, T. Saito2, N. Shikama3, T. Takahashi4, Y. Shioyama5, H. Harada6, M. Takeshima7, K. Yoshizawa7, T. Kosugi8, N. Imano9, S. Sekii10, T. Kawamoto3, O. Tanaka11, Y. Ohkubo12, and N. Nakamura13; 1Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan, 2Division of Integrative Medical Oncology, Saiseikai Kumamoto Hospital, Kumamoto, Japan, 3Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Tokyo, Japan, 4Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan, 5Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan, 6Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi, Japan, 7Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan, 8Department of Radiation Oncology, Fujieda Municipal General Hospital, Shizuoka, Japan, 9Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan, 10Department of Radiation Oncology, Osaka International Medical & Science Center, Osaka, Japan, 11Department of Radiation Oncology, Asahi University Hospital, Gifu, Japan, 12Department of Radiation Oncology, Saku Central Hospital Advanced Care Center, Saku, Japan, 13Department of Radiation Oncology, St. Marianna University Hospital, Kawasaki City, Japan
Purpose/Objective(s): This study aims to evaluate utilization rates of hemostatic treatments, including radiotherapy, endoscopic hemostasis, surgery, and interventional radiology, for patients with bleeding gastric cancer in Japan, using a commercially available nationwide claims database. Factors that affected receiving radiotherapy were also investigated.
Materials/Methods: Among 19,934,259 patients (Apr 2014–Dec 2022), 5,859 who received transfusions after diagnosis of gastric cancer were identified. After excluding those with other transfusion-requiring conditions (e.g. trauma, colorectal cancer, varix rupture, etc.), 5,523 patients presumed receiving transfusions for bleeding gastric cancer were included in this study. We collected data including received treatments (radiotherapy, endoscopic hemostasis, surgery, chemotherapy, interventional radiology) within 3 months post-transfusion.
Results: The median observation period after transfusion was 47 (0–113) months. The number of patients who received the various treatments were as follows: radiotherapy (n=286 [5.2%]), endoscopic hemostasis (n=711 [12.9%]), surgery (n=1,459 [26.4%]), and chemotherapy (n=159 [2.8%]). None of the patients received interventional radiology, and 3,329 (60.3%) patients did not receive any local hemostatic treatment. Multivariable analysis revealed that younger age, more hospital beds, treatment in a designated cancer hospital, no surgery, and the use of chemotherapy were all associated with receiving radiotherapy.
Conclusion: Radiotherapy, historically shown as a highly effective and low-toxicity treatment for bleeding gastric cancer, is rarely performed in Japan. The hospital type profoundly affected radiotherapy utilization, and a system that ensures equal access to radiotherapy regardless of the hospital type is necessary.
Abstract 3552 - Table 1: Logistic regression analyses to identify factors associated with receiving radiotherapy (n=5523)| Radiotherapy Yes 286 (5.2%) | Radiotherapy No 5237 (94.8%) | Univariable Odds ratio [95% CI] | Multivariable Odds ratio [95% CI] | ||
| Age at time of transfusion | Median (range) | 73 (34–95) | 78 (20–99) | 0.96 [0.95–0.97] | 0.96 [0.95–0.97] |
| Sex | Male Female | 216 70 | 3656 1581 | ref 0.75 [0.57–0.99] | ref 0.77 [0.58–1.02] |
| No. of transfusions | Median (range) | 2 (1–24) | 1 (1–52) | 1.02 [0.99–1.06] | 1.01 [0.98–1.05] |
| No. of beds | 20–299 300–499 500+ | 15 131 140 | 1426 2438 1373 | ref 5.11 [2.98–8.75] 9.69 [5.66–16.6] | ref 4.61 [2.68–7.92] 5.43 [3.07–9.62] |
| Business entity | University/National/Public Others | 49 237 | 820 4417 | ref 0.90 [0.65–1.23] | ref 1.23 [0.88–1.71] |
| Hospital type | Designated cancer hospital Others | 145 141 | 1251 3986 | ref 0.31 [0.24–0.39] | ref 0.44 [0.33–0.59] |
| Endoscopic hemostasis | No Yes | 252 34 | 4560 677 | ref 1.14 [0.81–1.60] | ref 1.02 [0.72–1.44] |
| Surgery | No Yes | 242 44 | 3822 1415 | ref 0.59 [0.43–0.80] | ref 0.54 [0.40–0.74] |
| Chemotherapy | No Yes | 269 17 | 5095 142 | ref 2.27 [1.35–3.81] | ref 1.94 [1.13–3.32] |