Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study

Abstract

Background: Deficiencies in care for cancer survivors may result from unclear roles for primary care providers (PCPs) and oncology specialists in follow-up.

Objectives: To compare cancer survivors' care to non-cancer controls.

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

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

Measurements: 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.