Journal of General Internal Medicine

, Volume 25, Issue 10, pp 1045–1050 | Cite as

Longitudinal Patterns in Survival, Comorbidity, Healthcare Utilization and Quality of Care among Older Women Following Breast Cancer Diagnosis

  • Amresh D. Hanchate
  • Kerri M. Clough-Gorr
  • Arlene S. Ash
  • Soe Soe Thwin
  • Rebecca A. Silliman
Original Research



To compare longitudinal patterns of health care utilization and quality of care for other health conditions between breast cancer-surviving older women and a matched cohort without breast cancer.


Prospective five-year longitudinal comparison of cases and matched controls.


Newly identified breast cancer patients recruited during 1997–1999 from four geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island; N = 422) were matched by age, race, baseline comorbidity and zip code location with up to four non-breast-cancer controls (N = 1,656).


Survival; numbers of hospitalized days and physician visits; total inpatient and outpatient Medicare payments; guideline monitoring for patients with cardiovascular disease and diabetes, and bone density testing and colorectal cancer screening.


Five-year survival was similar for cases and controls (80% and 82%, respectively; p = 0.18). In the first follow-up year, comorbidity burden and health care utilization were higher for cases (p < 0.01), with most differences diminishing over time. However, the number of physician visits was higher for cases (p < 0.01) in every year, driven partly by more cancer and surgical specialist visits. Cases and controls adhered similarly to recommended bone density testing, and monitoring of cardiovascular disease and diabetes; adherence to recommended colorectal cancer screening was better among cases.


Breast cancer survivors’ health care utilization and disease burden return to pre-diagnosis levels after one year, yet their greater use of outpatient care persists at least five years. Quality of care for other chronic health problems is similar for cases and controls.


survival case-control inpatient care outpatient care costs preventive care 



This work was supported by grants CA106979, CA/AG 70818, CA84506, and CA92395 from the National Cancer Institute.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Amresh D. Hanchate
    • 1
    • 2
  • Kerri M. Clough-Gorr
    • 3
    • 4
    • 5
  • Arlene S. Ash
    • 2
    • 6
  • Soe Soe Thwin
    • 3
    • 7
  • Rebecca A. Silliman
    • 3
    • 4
  1. 1.Center for Organization, Leadership and Management Research (COLMR), VA Boston Healthcare SystemBostonUSA
  2. 2.Health Care Research Unit, Section of General Internal MedicineBoston University School of MedicineBostonUSA
  3. 3.Section of GeriatricsBoston University School of MedicineBostonUSA
  4. 4.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  5. 5.National Institute for Cancer Epidemiology and Registration (NICER) Institute of Social and Preventative Medicine (ISPM)University of ZurichZurichSwitzerland
  6. 6.Department of Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA
  7. 7.Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC)VA Healthcare SystemBostonUSA

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