Association between fragmented care and incident mood disorder in elderly patients with colorectal cancer: a retrospective cohort study in South Korea.

Background: This study investigated the relationship between fragmented care (patient care provided at multiple hospitals) and incident mood disorders in elderly colorectal cancer patients. Fragmented care was defined as a change in the medical institution providing first cancer treatment within 180 days of cancer diagnosis. The aim of this study was to investigate the impact of fragmented care on the incidence of mood disorder after cancer diagnosis in elderly colorectal cancer patients.

Methods: This study used NHIS Senior cohort data between 2002 and 2019 in South Korea. The participants included individuals aged 60 to 80 years who were diagnosed with colorectal cancer between 2008 and 2014. The primary outcome measure was the incidence of mood disorders within five years after cancer diagnosis. The independent variable was fragmented care. Regression analysis was conducted using the Cox proportional hazard model, and a sensitivity analysis was performed to enhance the robustness of the study findings.

Results: Of the total 3,726 participants, 878 (23.6%) were diagnosed with mood disorders, and 328 (8.8%) experienced fragmented care. The mood disorder incidence rate per 100,000 person-days was higher among those who experienced fragmented care (18.9 cases) compared to those who did not (14.6 cases). Participants who received fragmented care had a significantly higher risk of incident mood disorders (hazard ratio 1.39, 95% confidence interval 1.10-1.77). The results of the sensitivity analysis, which extended the fragmented care observation period, remained consistent with the original findings. Additionally, subgroup analysis revealed that the effect of fragmented care on incident mood disorders was significantly associated with female sex, chronic diseases, lower economic status, and type of colon cancer (C18).

Conclusions: Fragmented care increased the risk of incident mood disorders within the first five years of diagnosis in elderly patients with colorectal cancer. The findings highlight the potentially important role of a cohesive health system in managing the mental health of patients with colorectal cancer, which is important considering that depression is relatively commonly found in these patients.