title: Primary care physician use across the breast cancer care continuum: CanIMPACT study using Canadian administrative data.
abstract: OBJECTIVE
  To describe primary care physician (PCP) use and continuity of PCP care across the breast cancer care continuum.
  
  
  METHODS
  Population-based, retrospective cohort study using provincial cancer registries linked to health administrative databases.
  
  
  METHODS
  British Columbia, Manitoba, and Ontario.
  
  
  METHODS
  All women with incident invasive breast cancer from 2007 to 2012 in Manitoba and Ontario and from 2007 to 2011 in British Columbia.
  
  
  METHODS
  The number and proportions of visits to PCPs were determined. Continuity of care was measured using the Usual Provider of Care index calculated as the proportion of visits to the most-often-visited PCP in the 6 to 30 months before a breast cancer diagnosis (baseline) and from 1 to 3 years following a breast cancer diagnosis (survivorship).
  
  
  RESULTS
  More than three-quarters of patients visited their PCPs 2 or more times during the breast cancer diagnostic period, and more than 80% of patients had at least 1 PCP visit during breast cancer adjuvant treatment. Contact with the PCP decreased over time during breast cancer survivorship. Of the 3 phases, women appeared to be most likely to not have PCP contact during adjuvant treatment, with 10.7% (Ontario) to 18.7% (British Columbia) of women having no PCP visits during this phase. However, a sizable minority of women had at least monthly visits during the treatment phase, particularly in Manitoba and Ontario, where approximately a quarter of women saw a PCP at least monthly. We observed higher continuity of care with PCPs in survivorship (compared with baseline) in all provinces.
  
  
  CONCLUSIONS
  Primary care physicians were generally involved throughout the breast cancer care continuum, but the level of involvement varied across care phases and by province. Future interventions will aim to further integrate primary and oncology care.
authors.affiliation: Epidemiologist with the Institute for Clinical Evaluative Sciences at Queen's University in Kingston, Ont. 11lj7@queensu.ca.
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Assistant Professor and Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto in Ontario.
authors.forename: Aisha
authors.initials: A
authors.lastname: Lofters
authors.affiliation: Professor and a senior biostatistician in the Department of Family and Community Medicine at the University of Toronto.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Senior epidemiologist in the Epidemiology and Cancer Registry Department at CancerCare Manitoba and Assistant Professor in the Department of Community Health Sciences at the University of Manitoba in Winnipeg.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Decker
authors.affiliation: Senior scientist in the Division of Cancer Care and Epidemiology at the Queen's Cancer Research Institute and Professor in the Department of Public Health Sciences at Queen's University.
authors.forename: Patti
authors.initials: P
authors.lastname: Groome
authors.affiliation: Doctoral candidate and Project Coordinator with the Cancer Outcomes Research Program at Dalhousie University in Halifax, NS.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendell
authors.affiliation: Researcher with the University Health Network and Clinical Lead of Quality Care and Access for the Systemic Treatment Program at Cancer Care Ontario in Toronto.
authors.forename: Monika
authors.initials: M
authors.lastname: Krzyzanowska
authors.affiliation: Biostatistical research methodologist at the BC Cancer Agency in Vancouver.
authors.forename: Dongdong
authors.initials: D
authors.lastname: Li
authors.affiliation: Distinguished Scientist in Cancer Control Research for the BC Cancer Agency and Clinical Professor in the School of Population and Public Health at the University of British Columbia.
authors.forename: Mary L
authors.initials: ML
authors.lastname: McBride
authors.affiliation: Chief Research Officer at Cancer Care Ontario.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: Professor and Ramia Chair in Surgical Oncology at Dalhousie University.
authors.forename: Geoff
authors.initials: G
authors.lastname: Porter
authors.affiliation: Epidemiologist and Provincial Director of the Population Oncology portfolio at CancerCare Manitoba, and Associate Professor in the Department of Community Health Sciences at the University of Manitoba.
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.affiliation: Assistant Professor and Ramia Scientist in the Department of Surgery at Dalhousie University.
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.affiliation: Clinical Associate Professor in the School of Medicine at Stanford University in California.
authors.forename: Marcy
authors.initials: M
authors.lastname: Winget
authors.affiliation: Biostatistical research methodologist at the BC Cancer Agency.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D001955:British Columbia / Q000453:epidemiology; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D058007:Physicians, Primary Care; D012189:Retrospective Studies