In a groundbreaking study published in BMC Cancer, researchers have illuminated the complex relationship between doctor-shopping behavior and survival rates among lung cancer patients in South Korea. Spanning an impressive 11 years and encompassing data from more than 280,000 individuals, this comprehensive analysis sheds new light on how patterns of medical consultations influence clinical outcomes in this notoriously deadly disease. The findings reveal a nuanced picture: while moderate engagement with multiple healthcare providers can be beneficial, excessive doctor shopping emerges as a detrimental factor, significantly reducing long-term survival.
The term "doctor shopping" describes the practice of patients visiting multiple physicians or healthcare facilities before receiving definitive treatment. In the context of lung cancer, a diagnosis often triggers urgency and anxiety, prompting patients to seek multiple opinions or treatments in search of the best possible care. However, whether this behavior confers a survival advantage or poses risks had remained largely unquantified until now. Leveraging Korea's National Health Insurance Service database, which compiles exhaustive claims data nationwide, the team led by Hong et al. undertook a rigorous examination of this behavior over a decade-plus timespan.
Using a well-curated cancer cohort that excluded patients based on specific criteria to ensure data robustness, the researchers identified 280,030 newly diagnosed lung cancer patients from 2009 to 2021. They meticulously tracked the number of doctor visits each patient undertook between the time of initial diagnosis and the commencement of treatment. This parameter, dubbed doctor-shopping behavior (DSB), was thoughtfully divided into four groups based on quartiles: minimal visits (Q1), moderate visits (Q2 and Q3), and excessive visits (Q4), allowing for nuanced analysis of its effects on mortality and survival.
Death rates were scrutinized at multiple time points: within 30 days, 90 days, and one year post-diagnosis, as well as overall survival beyond five years. Employing advanced multiple logistic regression models, the team adjusted for confounding variables to isolate the influence of doctor-shopping behaviors on patient outcomes. This methodological rigor ensured that the observed associations were not mere artifacts but reflected genuine trends with clinical significance.
Intriguingly, the findings revealed a protective effect associated with moderate doctor shopping. Patients who engaged in two to nine visits before treatment initiation exhibited a lower probability of dying within the initial critical periods after diagnosis -- 30 days, 90 days, and one year -- compared to those who had minimal or no doctor visits. Furthermore, these moderately engaged patients demonstrated a significantly increased likelihood of surviving beyond five years, a remarkable insight considering lung cancer's generally poor prognosis.
In stark contrast, the cohort with excessive doctor shopping, defined as more than ten visits prior to treatment onset, experienced markedly worse outcomes. The odds of mortality were significantly heightened across all measured time intervals for this group. Notably, their probability of surviving past five years decreased by approximately 12% compared to minimal visitors, indicating that excessive medical wandering might delay timely treatment or provoke fragmented care that harms survival.
The study's stratified analysis further revealed socioeconomic and geographical disparities accentuating the risks of doctor shopping. Middle-class or wealthier individuals residing in metropolitan areas who exhibited excessive doctor-shopping patterns showed a 14-18% increase in mortality within the first year of diagnosis and a 12-18% reduction in five-year survival rates compared to their counterparts with limited doctor visits. Such patterns could reflect greater access to numerous specialists, potentially leading to treatment delays or inconsistent care pathways.
These insights carry profound implications for healthcare policy and clinical practice. Lung cancer, a leading cause of cancer mortality worldwide, demands streamlined, high-quality care pathways to optimize outcomes. While seeking additional medical opinions can empower patients, excessive switching between providers without coordinated care may undermine treatment efficacy. Accordingly, the authors advocate for policies that regulate doctor-shopping tendencies, especially among patient groups with substantial healthcare access, to promote judicious use of medical resources and enhance survival outcomes.
Beyond survival statistics, this study underscores the importance of patient guidance and system-level interventions in oncology care. Educating patients about the risks and benefits of consulting multiple providers, coupled with improving referral systems and care continuity, could alleviate deleterious doctor-shopping behaviors. Meanwhile, healthcare providers should be attuned to patterns indicative of excessive doctor-shopping to address underlying concerns proactively.
This research also capitalizes on the power of claims data analytics, demonstrating how large-scale administrative datasets can inform epidemiological insights and health services research. The Korean National Health Insurance Service database's comprehensiveness allowed for granular investigation across a national population, overcoming typical limitations of small sample sizes or single institution studies that often restrict generalizability.
Importantly, this study's temporal breadth, covering over a decade, enabled the observation of long-term outcomes and trends that shorter studies cannot capture. The stability of the associations between DSB and survival over such an extended period strengthens confidence in the findings and highlights persistent patterns relevant for policymaking over time.
The revelation that moderate doctor shopping confers a survival benefit invites further research into the mechanisms involved. It is plausible that consulting multiple physicians facilitates second opinions, earlier detection of complications, or selection of optimal treatments. Conversely, analysis of the biological or psychological factors linked with excessive doctor shopping could reveal patient anxieties, systemic barriers, or healthcare inefficiencies underpinning poorer outcomes.
Moreover, the study sheds light on disparities in access and utilization of healthcare services in metropolitan versus rural settings, underscoring broader public health challenges. Strategies tailored to urban environments, where the temptation or opportunity for excessive doctor shopping is higher, may require nuanced intervention approaches distinct from rural areas.
The authors conclude by emphasizing the delicate balance between empowering patient autonomy and safeguarding clinical effectiveness. Optimizing lung cancer survival hinges not only on advanced therapies but also on effective healthcare navigation. Their findings challenge us to rethink how patients engage with medical systems and prompt the integration of behavioral insights into cancer care models.
This study represents a compelling advancement in understanding how patients' behavior before treatment initiation directly impacts survival outcomes in lung cancer. As healthcare systems worldwide grapple with optimizing resource allocation, these findings provide evidence that could shape future clinical guidelines and health policy reforms, ensuring more efficient and equitable cancer care delivery.
Hong, M., Yun, I., and Moon, J.Y.'s landmark study offers a vital roadmap for researchers, clinicians, and policymakers aiming to reconcile patient behaviors with outcome improvements in oncology. In an era where lung cancer therapies are rapidly evolving, such epidemiological analyses remain critical in informing holistic patient management strategies that go beyond the molecular and clinical to include behavioral dimensions.
Subject of Research: Impact of doctor-shopping behavior on survival outcomes in lung cancer patients in Korea.
Article Title: Impact of doctor-shopping behavior on patient survival in lung cancer: findings from a 11-year cohort study using Korean claims data.
Article References:
Hong, M., Yun, I. & Moon, J.Y. Impact of doctor-shopping behavior on patient survival in lung cancer: findings from a 11-year cohort study using Korean claims data. BMC Cancer 25, 914 (2025). https://doi.org/10.1186/s12885-024-13416-x