Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan

Autoři: Tsu Jen Kuo aff001;  Pei Chen Wu aff004;  Pei Ling Tang aff005;  Chun-Hao Yin aff005;  Chi Hsiang Chu aff008;  Yao-Min Hung aff010
Působiště autorů: Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan aff001;  Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan aff002;  Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan aff003;  Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan aff004;  Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan aff005;  Department of Nursing, Meiho University, Pingtung, Taiwan aff006;  College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan aff007;  Clinical Trial Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan aff008;  Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan aff009;  Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan aff010;  School of Medicine, National Yang Ming University, Taipei, Taiwan aff011;  Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan aff012
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225635



Cancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer.


A total of 14,240 working-age patients (20 <age ≤65 years) with oral cavity cancer treated with radiotherapy (RT) during 2000–2013 were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database. We evaluated the effects of the Continuity of Care Index (COCI) proposed by Bice and Boxerman, sociodemographic factors, and comorbidities on the survival rate. This study categorized COC into three groups—low (COCI < 0.23), intermediate (COCI = 0.23–0.37), and high (COCI ≥ 0.38)—according to the distribution of scores in our sample. A multivariate Cox proportional hazards regression model was used to determine the demographic factors and comorbidities associated with the survival rate.


Among all the relevant variables, low COCI, male sex, low socioeconomic status, no receipt of prior dental treatment before RT, residence outside northern Taiwan, chemotherapy receipt, and a history of diabetes increased the risk of mortality. Pre-RT dental evaluation and management was significantly associated with reduced post-RT mortality (adjusted hazard ratio [aHR] = 0.767, 95% confidence interval [CI] = 0.729–0.806, p < 0.001). Compared with patients with a high COCI, those with a low COCI exhibited an increased risk of mortality (aHR = 1.170, 95% CI = 1.093–1.252, p < 0.001). The mortality risk in the intermediate COC group was significantly higher than that in the high COC group (aHR = 1.194, 95% CI = 1.127–1.266, p < 0.001). To balance the distribution of the potential risk factors, propensity-score matching was used for the high COC (COCI > 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074–1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107–1.277, p = 0.001, respectively).


In Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers’ attention.

Klíčová slova:

Cancer treatment – Coronary heart disease – Death rates – Oncology – Physicians – Socioeconomic aspects of health – Taiwan


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