Aligning with optimal care pathways for people with colon cancer: Clinical, survival and cost implications across socioeconomic and geographic populations in Australia.

BACKGROUND

Optimal Care Pathways (OCPs) are national pathway-based frameworks designed to promote timely, coordinated, evidence-based cancer care through tumour-specific action points. However, population-level evidence on associations between OCP alignment, survival, and healthcare costs, remains limited.

OBJECTIVE

To examine factors associated with OCP alignment and its relationship with five-year survival and hospital costs among people with colon cancer in Victoria, Australia.

METHODS

A retrospective cohort study used linked administrative data from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset, and hospital cost collections (2009-2022). Adult colon cancer cases (ICD-10 C18) were classified by alignment with OCP action-points. Multivariable logistic regression identified predictors of OCP alignment. Five-year survival was analysed using parametric survival models, and generalised linear models examined associations between OCP alignment and hospital costs.

RESULTS

Among 26,260 colon cancer cases, OCP alignment was more common among patients with Stage II-III disease, females, and those from advantaged areas. Five-year survival improved following OCP implementation, with OCP-aligned care independently associated with better survival (HR 0.91, 95% CI 0.84-0.99). Total hospital costs did not differ significantly by alignment status, although, aligned care was associated with greater multidisciplinary service utilisation across domains. Disease stage was the strongest determinant of hospital costs.

CONCLUSIONS

Alignment with OCP action points was associated with improved survival without higher overall hospital costs. Persistent socioeconomic and geographic differences in alignment highlight the need for strategies to ensure benefits are realised across populations.