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

J Gen Intern Med. 2009 Apr;24(4):469-74. doi: 10.1007/s11606-009-0903-2. Epub 2009 Jan 21.


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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bone Density
  • Breast Neoplasms*
  • Cholesterol / blood
  • Colorectal Neoplasms / diagnosis
  • Female
  • Humans
  • Influenza Vaccines
  • Longitudinal Studies
  • Mammography
  • Medical Oncology
  • Physicians, Family / statistics & numerical data*
  • Preventive Health Services / statistics & numerical data*
  • Primary Health Care / standards*
  • Retrospective Studies
  • Vaccination


  • Influenza Vaccines
  • Cholesterol