Comparing Care for Breast Cancer Survivors to Non-Cancer Controls: A Five-Year Longitudinal Study
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Deficiencies in care for cancer survivors may result from unclear roles for primary care providers (PCPs) and oncology specialists in follow-up.
To compare cancer survivors’ care to non-cancer controls.
Retrospective, longitudinal, controlled study starting 366 days post-diagnosis.
Stage 1-3 breast cancer survivors age 65+ diagnosed in 1998 (n = 1961) and matched non-cancer controls (n = 1961).
Using the SEER-Medicare database, we examined the number of visits to PCPs, oncology specialists, and other physicians; receipt of influenza vaccination, cholesterol screening, colorectal cancer screening, bone densitometry, and mammography; and whether care receipt was associated with physician mix visited.
Survivors were consistently less likely to receive influenza vaccination, cholesterol screening, colorectal cancer screening, and bone densitometry but more likely to receive mammograms than controls (all p < 0.05). Over time, colorectal cancer screening and mammography decreased and influenza vaccination increased for both groups (all p < 0.0001). Trends over time in care receipt were similar for survivors and controls. In Year 1, survivors had more visits to PCPs but fewer visits to other physicians than controls (both p < 0.05). Over time, survivors’ visits to PCPs and other physicians increased and to oncology specialists decreased (all p < 0.0001). Controls’ visits to PCPs increased (p < 0.0001) faster than survivors’ (p = 0.003). Controls’ visits to other physicians increased (p < 0.0001) at a rate similar to survivors. Survivors who visited both a PCP and oncology specialist were most likely to receive each service.
Better coordination between PCPs and oncology specialists may improve care for older breast cancer survivors.
KEY WORDSbreast cancer preventive care survivorship
This research was funded through an institutional research grant from the American Cancer Society. Presented in part at the 2007 Society for General Internal Medicine Annual Meeting and in part at the Fourth Biennial Cancer Survivorship Research Conference.
Conflicts of Interest
The authors have no relationships with for-profit companies relevant to the subject matter addressed in this manuscript.
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