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Healthcare utilization in cancer survivors: six-month longitudinal cohort data

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Abstract

Purpose

To describe healthcare utilization and reasons for delaying medical care and to identify factors that influence high healthcare utilization and care delay among cancer survivors.

Methods

Baseline (n = 991) and 6 month follow-up data (n = 777) were collected among breast, prostate, and colorectal cancer survivors from 32 US cancer centers. Participants completed surveys on healthcare utilization (e.g., number of visits to specific providers) and delay of medical care. We categorized participants as high or low users based on median number of visits. We used logistic regression models to examine factors that predicted high healthcare utilization or delay.

Results

Survivors reported a median of 10.5 visits to healthcare providers and 28% reported ever delaying medical care over 6 months. Compared to prostate cancer survivors, breast and colorectal survivors were 2.4 times more likely (CI = 1.2–4.8) and 4 times more likely (CI = 2.2–7.3) to be high healthcare users, respectively. A higher quality of life score predicted high healthcare utilization (OR = 2.4, CI = 2.0–2.8) and delay of medical care (OR = 1.8, CI = 1.5–2.2). Black survivors were 1.5 times more likely than White survivors to be high healthcare users (CI = 1.1–2.0) and respondents reporting a race category other than White or Black were 1.8 times more likely to delay care (CI = 1.3–2.5). Lower levels of self-efficacy predicted greater healthcare use (OR = 0.7, CI = 0.6–0.8) and delay (OR = 0.6, CI = 0.5–0.7).

Conclusion

Our findings suggest that race, education, marital status, cancer type, time since diagnosis, quality of life, and self-efficacy are associated with both high healthcare utilization and delay among cancer survivors.

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Data availability

Enquiries about data availability should be directed to the authors.

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Acknowledgments

Patricia Berglund, University of Michigan Institute for Social Research, for her assistance with IVEware installation and methods. Thanks to all the participants and institutions who participated in this study.

Funding

This study was funded by Patient Centered Outcomes Research Institute, PCORI-ID IH-12–11-5255. Data collection was supported by the Clinical and Translational Science Institute at the Children’s National (CTSI-CN) which is funded through the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) Program, grant UL1TR001876 and KL2TR001877. The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS). The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Authors and Affiliations

  1. Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA

    Nicole Gonzalez

  2. Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA

    K. Holly Mead

  3. Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, 20052, USA

    Mandi L. Pratt-Chapman

  4. GW Cancer Center, Washington, DC, 20052, USA

    Mandi L. Pratt-Chapman

  5. Healthcare Delivery Research Program, MedStar Health Research Institute, Washington, DC, 20008, USA

    Hannah Arem

  6. Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA

    Hannah Arem

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  1. Nicole Gonzalez
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  4. Hannah Arem
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Correspondence to Hannah Arem.

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Gonzalez, N., Mead, K.H., Pratt-Chapman, M.L. et al. Healthcare utilization in cancer survivors: six-month longitudinal cohort data. Cancer Causes Control 33, 1005–1012 (2022). https://doi.org/10.1007/s10552-022-01587-6

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  • DOI: https://doi.org/10.1007/s10552-022-01587-6

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