Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis.
OBJECTIVE
To compare longitudinal patterns of health care utilization and quality of care for other health conditions between breast cancer-surviving older women and a matched cohort without breast cancer.


METHODS
Prospective five-year longitudinal comparison of cases and matched controls.


METHODS
Newly identified breast cancer patients recruited during 1997-1999 from four geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island; N = 422) were matched by age, race, baseline comorbidity and zip code location with up to four non-breast-cancer controls (N = 1,656).


RESULTS
Survival; numbers of hospitalized days and physician visits; total inpatient and outpatient Medicare payments; guideline monitoring for patients with cardiovascular disease and diabetes, and bone density testing and colorectal cancer screening.


RESULTS
Five-year survival was similar for cases and controls (80% and 82%, respectively; p = 0.18). In the first follow-up year, comorbidity burden and health care utilization were higher for cases (p < 0.01), with most differences diminishing over time. However, the number of physician visits was higher for cases (p < 0.01) in every year, driven partly by more cancer and surgical specialist visits. Cases and controls adhered similarly to recommended bone density testing, and monitoring of cardiovascular disease and diabetes; adherence to recommended colorectal cancer screening was better among cases.


CONCLUSIONS
Breast cancer survivors' health care utilization and disease burden return to pre-diagnosis levels after one year, yet their greater use of outpatient care persists at least five years. Quality of care for other chronic health problems is similar for cases and controls.
Hanchate
Amresh D
AD
Center for Organization, Leadership and Management Research (COLMR), VA Boston Healthcare System, Boston, MA, USA. hanchate@bu.edu
Clough-Gorr
Kerri M
KM
Ash
Arlene S
AS
Thwin
Soe Soe
SS
Silliman
Rebecca A
RA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011787:Quality of Health Care / Q000639:trends*; D015996:Survival Rate / Q000639:trends