title: The Relationship Between Cancer Survivors' Socioeconomic Status and Reports of Follow-up Care Discussions with Providers.
abstract: Socioeconomically disadvantaged cancer survivors are less likely to have adequate follow-up care. In this study, we examined whether socioeconomically disadvantaged survivors are at risk for not having follow-up care discussions with providers, a critical determinant of access to follow-up care and desirable health outcomes. Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, we used a binary logit model with sample weights to examine associations between 1320 cancer survivors' socioeconomic status (SES) and reports of follow-up care discussions with providers, controlling for clinical and demographic characteristics. The multivariable model indicated survivors with incomes ≤200 % Federal Poverty Level (FPL) had a lower probability of reporting a follow-up care discussion than survivors with incomes >400 % FPL (p < 0.05). Survivors with less than high school education had a lower probability of reporting a discussion than survivors who had a college education or greater (p < 0.05). However, even after controlling for income, survivors with financial hardship had a greater probability of reporting a discussion than survivors with no financial hardship (p < 0.05). Insurance status was not a significant predictor of reporting a discussion (p > 0.05). Socioeconomically disadvantaged cancer survivors are at risk for not having follow-up care discussions with providers, particularly those who report lower income and education. The development of educational interventions targeting provider communication with socioeconomically disadvantaged cancer survivors, and survivors' understanding of the benefits of follow-up care discussions, may promote access to these services. Future research assessing mechanisms underlying relationships between survivors' SES indicators and reports of follow-up care discussions with providers is also warranted.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, CB 7411, Chapel Hill, NC, 27599-7411, USA. lisa.dimartino@unc.edu.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: DiMartino
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, CB 7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Birken
authors.affiliation: School of Nursing, University of North Carolina , CB 7460, Chapel Hill, NC, 27599-7460, USA.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000073116:Cancer Survivors / Q000706:statistics & numerical data*; D003142:Communication; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010817:Physician-Patient Relations; D011203:Poverty; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Follow-up care discussions; Medical expenditure panel survey; Socioeconomic status; Survivorship