Receipt of general medical care by colorectal cancer patients: a longitudinal study

Abstract

Background: cancer diagnosis has the potential to overshadow patients' general medical care needs. This study examined changes in general medical care among elderly patients with colorectal cancer (CRC), from before diagnosis through long-term survival.

Methods: this longitudinal cohort study used 1993 to 1999 Surveillance, Epidemiology, and End Results and 1991 to 2001 Medicare claims data for 22,161 patients with stage 0 to 3 CRC and 81,669 controls aged 67 to 89 years. Outcomes were preventive services (influenza vaccination, mammography) and, among diabetics, HgbA1c and lipid testing in the phase before diagnosis, the phase after initial treatment, the surveillance phase, and the survival care phase. Logistic regression provided adjusted relative risks of care receipt for patients with stage 0 to 1 cancer, stage 2 to 3 cancer, and no cancer.

Results: in the phase before diagnosis through the surveillance phase, patients with stage 0 to 1 CRC had the highest annual preventive service rates. Patients with stage 2 to 3 CRC made substantial gains in preventive service use, especially mammography, after diagnosis (influenza vaccination, 46.4% before diagnosis to 50.2% after initial treatment; mammography, 31.4% before diagnosis to 40.2% after initial treatment) but not in diabetes care (eg, HgbA1c, 53.4% before diagnosis to 54.9% after initial treatment).

Conclusions: CRC diagnosis seems to facilitate receipt of preventive services but not diabetes care for elderly, later-stage patients. Additional strategies such as strengthening partnerships between cancer patients, primary care physicians, and cancer care physicians are needed to improve care for a chronic disease like diabetes.

Figure 1

Study care phases.

Figure 2

Adjusted relative risk of influenza vaccination, mammography, and diabetes care measures (hemoglobin A1c and lipid testing) by cancer/control status and phase. Adjusted for the following variables: age, sex (when applicable), race ethnicity, median annual household income in ZIP code percent of those ≥25 years old who graduated from high school in zip code, reason for Medicare, National Cancer Institue combined comorbidity index, and number of hospitalizations. Note that relative risk scales differ for each measure.