Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study.
BACKGROUND
Deficiencies in care for cancer survivors may result from unclear roles for primary care providers (PCPs) and oncology specialists in follow-up.


OBJECTIVE
To compare cancer survivors' care to non-cancer controls.


METHODS
Retrospective, longitudinal, controlled study starting 366 days post-diagnosis.


METHODS
Stage 1-3 breast cancer survivors age 65+ diagnosed in 1998 (n = 1961) and matched non-cancer controls (n = 1961).


METHODS
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.


RESULTS
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.


CONCLUSIONS
Better coordination between PCPs and oncology specialists may improve care for older breast cancer survivors.
Snyder
Claire F
CF
Johns Hopkins School of Medicine, Baltimore, MD, USA. csnyder@jhsph.edu
Frick
Kevin D
KD
Peairs
Kimberly S
KS
Kantsiper
Melinda E
ME
Herbert
Robert J
RJ
Blackford
Amanda L
AL
Wolff
Antonio C
AC
Earle
Craig C
CC
D000368:Aged; D015519:Bone Density; D001943:Breast Neoplasms; D002784:Cholesterol / Q000097:blood; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D007252:Influenza Vaccines; D008137:Longitudinal Studies; D008327:Mammography; D008495:Medical Oncology; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies; D014611:Vaccination
D007252:Influenza Vaccines; D002784:Cholesterol