title: Continuity of care and early diagnosis of head and neck cancer.
abstract: This study investigated whether receiving continuous regular care with the same primary care provider had an independent association with stage at diagnosis for head and neck cancers (HNCA) in a Medicare population. The study database (N = 10,662) linked files from the Surveillance, Epidemiology, and End Results Program 1991-2000 for patients with cancers of the oral cavity, pharynx, and larynx with their files from the Center for Medicare and Medicaid Services Program. Continuity of care displayed a statistically significant independent association and dose-response pattern with stage at diagnosis when the provider was an internist but not a general or family physician. An independent statistically significant association between continuity of care with an internist and stage at diagnosis was found for oral cavity tumors (adjusted odds ratio [AOR] = 0.85; 95%CI = 0.73-0.99), but not pharyngeal tumors (AOR = 1.02; 95%CI = 0.74-1.41). Laryngeal tumors were borderline statistically significant at p-value = 0.07 (AOR = 0.84; 95%CI = 0.69-1.02). Regular continuous care from the same primary care provider displayed an independent association with early diagnosis of HNCA when the anatomic site was the oral cavity and the provider was an internist, but not when the provider was a general or family physician. Primary care physicians including general/family physicians may represent a relevant group for encouraging increased opportunistic HNCA screening efforts among their patients.
authors.affiliation: Department of Health Promotion and Policy, Health Services Research Program, School of Dentistry, University of Maryland, Baltimore, 21201, USA. BReid@umaryland.edu
authors.forename: Britt C
authors.initials: BC
authors.lastname: Reid
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care; D042241:Early Diagnosis; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006302:Health Services Research; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States