title: Identification of health care needs of long-term breast cancer survivors among Israeli women.
abstract: OBJECTIVE
  Improvement in treatment has extended survival of breast cancer patients. Our study aimed to characterize health service use among long-term breast cancer survivors in Israel in order to identify and address specific needs of this subpopulation.
  
  
  METHODS
  The study population included 250 women diagnosed with breast cancer, 8-12 years prior to study initiation (cases), and 250 individually matched cancer-free controls. Participants were recruited from the second largest Israeli HMO, and data were collected through personal interviews. ORs and 95 % CIs were estimated using conditional logistic regression and generalized estimating equations.
  
  
  RESULTS
  Greater use of health services was observed among cases, compared to an age-matched comparison group, expressed by more visits to family physicians and specialists, longer duration of visits, more requests for referrals, more frequent contact with emergency services, and hospitalizations. The study groups were similar regarding socioeconomic variables, current smoking and physical activity, BMI, and prevalence of reported morbidity. Although 80 % of cases defined the family physician as their main treating physician, half still considered their oncologist responsible for cancer follow-up. Only 14.4 and 10.4 % of cases and controls, respectively, reported receiving psychological support during the year preceding the interview.
  
  
  CONCLUSIONS
  Further studies should assess the contribution of apprehension concerning health-related issues that still accompany breast cancer survivors, to the excess use of health services. Concern among family practitioners may contribute as well. In addition, our results emphasize the need to improve coordination between the disciplines of oncology and community medicine for the medical care of this group.
authors.affiliation: Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel.
authors.forename: Lori
authors.initials: L
authors.lastname: Mandelzweig
authors.affiliation: Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel.
authors.forename: Angela
authors.initials: A
authors.lastname: Chetrit
authors.affiliation: Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel.
authors.forename: Tova
authors.initials: T
authors.lastname: Amitai
authors.affiliation: Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel.
authors.forename: Bernice
authors.initials: B
authors.lastname: Oberman
authors.affiliation: Maccabi Health Services, Tel Aviv, Israel.
authors.forename: Nava Siegelmann
authors.initials: NS
authors.lastname: Danieli
authors.affiliation: Israel National Cancer Registry, Jerusalem, Israel.
authors.forename: Barbara
authors.initials: B
authors.lastname: Silverman
authors.affiliation: Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel. siegals@gertner.health.gov.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. siegals@gertner.health.gov.il.
authors.forename: Siegal
authors.initials: S
authors.lastname: Sadetzki
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy*; D005260:Female; D006801:Humans; D007557:Israel; D020380:Needs Assessment; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology*
keywords: Breast cancer; Cancer survivors; Care needs; Health service use; Satisfaction with health services