title: Preventive care for colorectal cancer survivors: a 5-year longitudinal study.
abstract: OBJECTIVE
  To explore the mix of physician specialties that long-term survivors visit and how the mix relates to preventive care.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results-Medicare database, we conducted a retrospective, longitudinal study of stage I to III Medicare fee-for-service colorectal cancer patients diagnosed in 1997. We examined physician visits and preventive care each year for 5 years, starting 366 days postdiagnosis, and how preventive service receipt related to the physician mix seen: primary care provider (PCP) only, oncologist only, both, or neither.
  
  
  RESULTS
  A total of 1,541 patients met the eligibility criteria (mean age, 76; 43% male; 85% white). During 5 years, PCP visits increased from a mean of 4.2 to 4.7 (P < .0001), and oncology visits decreased from 1.3 to 0.5 (P < .0001). Survivor care by PCPs only increased from 44% to 62%, whereas shared care by PCPs and oncologists dropped from 37% to 21% (P < .0001). Survivors who saw both PCPs and oncologists were most likely to receive influenza vaccination, mammograms, and cervical cancer screening; survivors who saw PCPs only were most likely to receive cholesterol screening and bone densitometry. Higher socioeconomic status was associated with increased influenza vaccination, mammograms, and cervical cancer screening (P < .05). Over time, there was a decrease in mammography and cervical cancer screening and an increase in influenza vaccination (P < .05).
  
  
  CONCLUSIONS
  As oncologists become less involved in survivor care, cancer-related screening decreases significantly. These results support the need for survivorship care plans that explicitly outline the roles of PCPs and oncologists in sharing care for cancer survivors, and how these roles may change over time.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, 624 N Broadway, Room 657, Baltimore, MD 21205, USA. csnyder@jhsph.edu
authors.forename: Claire F
authors.initials: CF
authors.lastname: Snyder
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herbert
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008327:Mammography; D009364:Neoplasm Recurrence, Local; D011314:Preventive Health Services; D012189:Retrospective Studies; D018426:SEER Program; D017741:Survivors