Screening mammography rate and predictors following treatment for colorectal cancer

Introduction  Colorectal cancer survivors remain at risk for breast cancer. Thus, it is important to determine if screening mammography rates are reduced by the diagnosis and treatment of incident colorectal cancer. Methods  Mammography rates among 7,666 67–79 year-old stage 0-III colorectal cancer survivors were compared with rates among 36,433 age-, race/ethnicity-, SEER area-matched women controlling for pre-diagnosis mammography, stage, chemotherapy, income, co-morbidities, treatment in teaching hospital, number of physician visits, and gynecologist visits. Results  In the first 2 years after diagnosis, the survivors’ rate (49.7/100) was 4.2% higher than the controls’ (47.6/100), p < 0.001. It was 7.5% higher in the next 2 years, 54.5/100 versus 49.7/100, p < 0.001. The higher rates resulted from significantly greater rates among survivors without prior mammography, 30.9/100, compared with their controls (25.3/100) in the first 2 years, for example (O.R. = 1.23, 95% C.I. = 1.15–1.32). The strongest predictors of post-diagnosis mammography were pre-diagnosis mammography (O.R. = 5.76, 95% C.I. = 5.19–6.38), visiting a gynecologist (O.R. = 1.83, 95% C.I. = 1.55–2.16), chemotherapy (O.R. = 1.61, 95% C.I. = 1.40–1.86), and more than nine physician visits. Increasing Charlson scores and cancer stage were associated with lower mammography rates. Discussion/Conclusions  Overall, the competing demands of cancer diagnosis and treatment did not reduce mammography rates, and these events were associated with increased rates among previous non-users. Implications for cancer survivors  The low mammography rate among survivors with no history of a prior mammogram means that the physicians treating these women must emphasize the need for such care.     

Patterns and predictors of mammography utilization among breast cancer survivors

BACKGROUND: Improvements in cancer detection and treatment have resulted in increasing numbers of breast cancer survivors. Information regarding the use of mammography by breast cancer survivors is limited. METHODS: The use of surveillance mammography was examined over a 5-year period in a retrospective cohort of women age>or=55 years who were diagnosed with incident primary breast cancer (1996-1997) while enrolled in 1 of 4 geographically diverse integrated health systems. RESULTS: Of the 797 women included in the study, 80% (n=636) underwent mammograms during the first year after treatment for breast cancer. The percentage of women having mammograms during each yearly period decreased significantly over time. In multivariable analyses, older women with comorbid illnesses or those with late-stage disease were less likely to undergo mammograms, whereas those who underwent breast-conserving therapy (adjusted odds ratio [OR] of 1.38 [95% confidence interval (95% CI), 1.09-1.75]) were more likely to have mammograms. Women who had outpatient visits with a gynecologist (adjusted OR of 3.49 [95% CI, 2.55-4.79]), or a primary care physician (adjusted OR of 2.21 [95% CI, 1.73-2.82]) during the year were more likely to undergo mammograms in that year. CONCLUSIONS: The use of mammography among breast cancer survivors declines over time. Efforts are needed to increase awareness among healthcare providers and breast cancer survivors of the value of follow-up mammography. The current findings highlight the importance of maintaining ongoing contact with primary care physicians and gynecologists.     

Physician visits and preventive care among Asian American and Pacific Islander long-term survivors of colorectal cancer,USA, 1996–2006

Purpose

Published literature on receipt of preventive healthcare services among Asian American and Pacific Islander (API) cancer survivors is scarce. We describe patterns in receipt of preventive services among API long-term colorectal cancer (CRC) survivors.

Methods

Surveillance, Epidemiology, and End Results registry–Medicare data were used to identify 9,737 API and white patients who were diagnosed with CRC during 1996–2000 and who survived 5 or more years beyond their diagnoses. We examined receipt of vaccines, mammography (females), bone densitometry (females), and cholesterol screening among the survivors and how the physician specialties they visited for follow-up care correlated to services received.

Results

APIs were less likely than whites to receive mammography (52.0 vs. 69.3 %, respectively; P?<?0.0001) but more likely to receive influenza vaccine, cholesterol screening, and bone densitometry. These findings remained significant in our multivariable model, except for receipt of bone densitometry. APIs visited PCPs only and both PCPs and oncologists more frequently than whites (P?<?0.0001). Women who visited both PCPs and oncologists compared with PCPs only were more likely to receive mammography (odds ratio?=?1.40; 95 % confidence interval, 1.05–1.86).

Conclusions

Visits to both PCPs and oncologists were associated with increased use of mammography. Although API survivors visited these specialties more frequently than white survivors, API women may need culturally appropriate outreach to increase their use of this test.

Implications for Cancer Survivors

Long-term cancer survivors need to be aware of recommended preventive healthcare services, as well as who will manage their primary care and cancer surveillance follow-up.     

Physician and patient characteristics associated with outpatient breast cancer screening recommendations in the United States: analysis of the National Ambulatory Medical Care Survey Data 1996–2004

Background The primary goal of breast cancer screening tests is to find cancer at an early stage before a person has any symptoms. Evidence suggests that screening examinations such as mammography and clinical breast examinations (CBE) are effective in early detection of breast cancer. Physician recommendation is an important reason many women undergo screening. This study examined the physician and patients related factors associated with physician recommendations for breast cancer screening in the United States (US) outpatient settings. Methods This cross-sectional study used data from the National Ambulatory Medical Care Survey (NAMCS) from 1996–2004. Women aged ≥40 years were included in the study sample. Multivariate logistic regression analyses were used to study the objectives. Results Weighted analysis indicated that physicians performed 198 million CBEs and made 110 million mammography recommendations over the study period (1996–2004). Patients’ age, duration of visits, history of previous breast cancer diagnosis, and source of insurance were significant predictors of screening recommendations in this population. Obstetricians and gynecologists were more likely to perform a CBE and recommend mammography than other specialty physicians. Conclusions These findings indicated that there were certain disparities regarding the physician recommendations of breast cancer screening for women in the US outpatient settings.     

Surveillance mammography and the risk of death among elderly breast cancer patients

Purpose To examine the benefits of mammography for elderly breast cancer survivors in community settings. Methods Using the 1991–1999 linked SEER-Medicare data, we examined if mammography reduced the risk of breast-cancer-specific and all-cause mortality among women age 66 or older who were diagnosed with first primary breast cancer (FPBC) at stages 0–III and survived at least 30 months. To analyze the influence of mammography (both within one year and within two years prior to death/censoring) on the risk of breast-cancer-specific mortality, we compared women who died of breast cancer (cases) with women who died of other causes or were censored (controls). For an analysis of all-cause mortality, we compared women who died from any cause (cases) with women who were censored (controls). Propensity scores were used to adjust for tumor-related, treatment-related, and sociodemographic confounders. Results Among 1351 breast cancer deaths (cases) and 5,262 controls, women who had a mammogram during a one or two-year time interval were less likely to die from breast cancer than women who did not have any mammograms during this time period in propensity-score-adjusted analysis (within one year odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.72–0.95; within two years OR: 0.80, 95% CI: 0.70–0.92). Similarly, risk of all-cause mortality was reduced among women who had mammograms during one- or two-year intervals. Conclusions In community settings, mammography use during a one- or two-year time interval was associated with a small-reduced risk of breast-cancer-specific and all-cause mortality among elderly breast cancer survivors.     

Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors

Clinical practice guidelines recommend yearly surveillance mammography for breast cancer survivors, yet many women do not receive this service. The objective of this study was to evaluate factors related to long-term surveillance mammography adherence among breast cancer survivors. We conducted a retrospective cohort study among women ≥18 years, diagnosed with incident stage I or II breast cancer between 1990 and 2008. We used medical record and administrative health plan data to ascertain covariates and receipt of surveillance mammography for up to 10 years after completing breast cancer treatment. Surveillance included post-diagnosis screening exams among asymptomatic women. We used multivariable repeated measures generalized estimating equation regression models to estimate odds ratios and robust 95 % confidence intervals to examine factors related to the annual receipt of surveillance mammography. The analysis included 3,965 women followed for a median of six surveillance years; 79 % received surveillance mammograms in year 1 but decreased to 63 % in year 10. In multivariable analyses, women, who were <40 years or 80+ years of age (compared to 50–59 years), current smokers, had greater comorbidity, were diagnosed more recently, had stage II cancer, or were treated with mastectomy or breast conserving surgery without radiation, were less likely than other women to receive surveillance mammography. Women with outpatient visits during the year to primary care providers, oncologists, or both were more likely to undergo surveillance. In this large cohort study of women diagnosed with early-stage invasive breast cancer, we found that important subgroups of women are at high risk for non-adherence to surveillance recommendations, even among younger breast cancer survivors. Efforts should be undertaken to actively engage breast cancer survivors in managing long-term surveillance care.     

Under use of necessary care among cancer survivors

Comorbid conditions are the major threat to life for many cancer survivors, yet little is known about the quality of the noncancer-related health care they receive. The authors analyzed the Medicare claims of 14,884 Medicare-eligible, 5-year colorectal carcinoma survivors who were diagnosed initially while they lived in a region monitored by the Surveillance, Epidemiology, and End Results (SEER) Program and compared them with matched controls who had no history of cancer drawn from the Medicare 5% sample. In both univariable and multivariable analyses, cancer survivorship was associated with an increased likelihood of not receiving recommended care across a broad range of chronic medical conditions (odds ratio, 1.19, 95% confidence interval, 1.12-1.27). For example, colorectal carcinoma survivors were less likely than controls to receive appropriate follow-up for heart failure, necessary diabetic care, or recommended preventive services. Having both primary care physicians and oncologists involved in follow-up appeared to ameliorate this effect significantly. African-American, poor, and elderly patients were less likely to receive necessary care in both groups. Whether it was due to patient factors, physician factors, or both, cancer survivors appear to be a vulnerable patient population, because their cancer diagnosis may shift attention away from important noncancer problems and providers. In addition, there may be lack of clarity around the relative roles primary care and specialist physicians will play in a survivor's care. Special attention and education are needed to ensure that survivors receive optimal medical services.     

Mental health service utilization among long-term cancer survivors

Background Although generally well-adjusted, a subset of cancer survivors have been observed to experience ongoing psychological distress. There has been little study of mental health care utilization among cancer survivors, however. Materials and methods We identified a cohort of cancer survivors continuously enrolled in a managed care organization who were alive at least 5 years after a diagnosis of cancer and without evidence of recurrence. We matched them each to four controls without a history of cancer based on age, sex, and clinic location. We then obtained their health care claims and evaluated their health care utilization along with explanatory variables such as cancer type, non-cancer comorbid conditions, and types of health care providers seen. Results One thousand one hundred eleven survivors were matched to 4,444 controls. Cancer survivors were more likely than controls to have a mental health diagnosis (33.5 vs. 30.3%, p < 0.05), accounted for mostly by anxiety and sleep disorders. Other predictors of receiving any mental health diagnosis on multivariable analysis were age: Odds Ratio (OR) 0.99 (95% Confidence Interval (CI) 0.99–0.99) for each year; male sex: OR 0.87 (95% CI 0.77–0.99), and comorbidity: OR 0.56 (95% CI 0.49–0.64) for each point on the Charlson scale. The largest subgroup was breast cancer survivors, who were more likely to have a diagnosis of major affective disorder than were female survivors of other cancers. Survivors had more outpatient medical visits in general (mean 27.4 versus 21.9, p < 0.001) and specifically more mental health visits (2.5 versus 1.7 on average, p < 0.001) than did controls. Conclusion Long-term cancer survivors have increased rates of mental health care utilization. Given the size and growth of the survivor population, this represents a significant amount of ongoing distress with important health resource allocation implications for policy makers.     

Comorbidities and mammography use interact to explain racial/ethnic disparities in breast cancer stage at diagnosis

BACKGROUND:

Interactions with comorbidity burden and comorbidity‐related care have not been examined as potential explanations for racial/ethnic disparities in advanced‐stage breast cancer at diagnosis.

METHODS:

The authors used linked Surveillance, Epidemiology, and End Results‐Medicare data to determine whether comorbidity burden and comorbidity‐related care are associated with stage at diagnosis, whether these associations are mediated by mammography use, and whether they explain racial/ethnic disparities. Stage at diagnosis and mammography use were analyzed in multivariate regression models, adjusting for comorbidity burden and comorbidity‐race interactions among 118,742 women diagnosed with breast cancer during 1993 to 2005.

RESULTS:

Mammography utilization was higher among women with ≥3 stable comorbidities than among those without comorbidities. Advanced stage at diagnosis was associated with black race (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6‐1.8), Hispanic ethnicity (OR, 1.3; 95% CI, 1.2‐1.5), unstable comorbidity, and age ≥80 years. Mammography was protective in all racial/ethnic groups, but neither mammography use (OR, 0.3; 95% CI, 0.3‐0.3 and OR, 0.2; 95% CI, 0.2‐0.2 for women with 1 and ≥2 prior mammograms, respectively) nor overall physician service use (OR, 0.7; 95% CI, 0.7‐0.8 for women with ≥16 visits) explained the association between race/ethnicity and stage at diagnosis. The black/white OR fell to 1.2 (95% CI, 0.9‐1.5) among women with multiple stable comorbidities who received ≥2 screening mammograms, and 1.0 (95% CI, 0.8‐1.3) among mammography users with unstable comorbidities.

CONCLUSIONS:

Comorbidity burden was associated with regular mammography and earlier stage at diagnosis. Racial/ethnic disparities in late stage disease were reduced among women who received both regular mammograms and comorbidity‐related care. Cancer 2011. © 2011 American Cancer Society.     

Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer

Annual surveillance mammograms in older long-term breast cancer survivors are recommended, but this recommendation is based on little evidence and with no guidelines on when to stop. Surveillance mammograms should decrease breast cancer mortality by detecting second breast cancer events at an earlier stage. We examined the association between surveillance mammography beyond 5 years after diagnosis on breast cancer-specific mortality in a cohort of women aged ≥65 years diagnosed 1990–1994 with early stage breast cancer. Our cohort included women who survived disease free for ≥5 years (N = 1,235) and were followed from year 6 through death, disenrollment, or 15 years after diagnosis. Asymptomatic surveillance mammograms were ascertained through medical record review. We used Cox proportional hazards regression stratified by follow-up year to calculate the association between time-varying surveillance mammography and breast cancer-specific and other-than-breast mortality adjusting for site, stage, primary surgery type, age and time-varying Charlson Comorbidity Index. The majority (85 %) of the 1,235 5-year breast cancer survivors received ≥1 surveillance mammogram in years 5–9 (yearly proportions ranged from 48 to 58 %); 82 % of women received ≥1 surveillance mammogram in years 10–14. A total of 120 women died of breast cancer and 393 women died from other causes (average follow-up 7.3 years). Multivariable models and lasagna plots suggested a modest reduction in breast cancer-specific mortality with surveillance mammogram receipt in the preceding year (IRR 0.82, 95 % CI 0.56–1.19, p = 0.29); the association with other-cause mortality was 0.95 (95 % CI 0.78–1.17, p = 0.64). Among older breast cancer survivors, surveillance mammography may reduce breast cancer-specific mortality even after 5 years of disease-free survival. Continuing surveillance mammography in older breast cancer survivors likely requires physician–patient discussions similar to those recommended for screening, taking into account comorbid conditions and life-expectancy.     

Care of long‐term cancer survivors

BACKGROUND:

Studies have shown that follow‐up care for cancer patients differs by physician specialty, and that coordination between specialists and generalists results in better care. Little is known, however, regarding which specialties of physicians provide care to long‐term cancer survivors.

METHODS:

The authors used Surveillance, Epidemiology, and End Results data from 1992 through 1997 that were linked to 1997‐2003 Medicare data to identify persons diagnosed >5 years earlier with bladder, female breast, colorectal, prostate, or uterine cancer. Physician specialties were assigned by combining Medicare data with the American Medical Association Masterfile and the Unique Physician Identification Number Registry. The percentage of long‐term survivors who visited physicians of interest was determined by analyzing Medicare outpatient claims submitted 6 to 12 years after initial diagnosis.

RESULTS:

Over the entire study period, 46% of female breast cancer survivors, 26% of colorectal cancer survivors, and 14% of prostate cancer survivors saw hematologists/oncologists. Radiation oncologists were seen by 11%, 2%, and 14% of breast, colorectal, and prostate cancer survivors, respectively. Survivors also sought care from specialists related to their cancer: 19% of breast cancer survivors had a cancer‐coded visit with a surgeon, 26% of colorectal cancer survivors visited a gastroenterologist, and 68% of prostate cancer survivors visited a urologist. The percentage of survivors who visited cancer and cancer‐related physicians declined each year. In contrast, nearly 75% of female breast, colorectal, and prostate cancer survivors saw primary care providers, and these percentages did not decrease annually.

CONCLUSIONS:

The findings of the current study underscore the need to include both primary care providers and cancer‐related specialists in education and guidelines regarding cancer survivorship. Cancer 2009. © 2009 American Cancer Society.     

Comorbidities, therapy, and newly diagnosed conditions for women with early stage breast cancer

Purpose  To describe comorbidities in breast cancer patients at diagnosis and examine factors associated with self-reported comorbidities 30 months post-diagnosis. Methods  Nine hundred forty one of 1,171 women had a medical record abstract and a follow-up survey in the Health, Eating, Activity and Lifestyle Study. Results  We compared our breast cancer cohort to a contemporaneous nationally-representative sample of age, race/ethnicity and education matched women without cancer (n = 865). Breast cancer patients did not have substantially more comorbidities than women without breast cancer. Women with a hospital record of congestive heart failure significantly less often received chemotherapy or radiation following breast conserving surgery. In multivariate analysis, women who received chemotherapy alone (OR = 3.2; 95% CI: 1.5–6.8), chemotherapy plus radiation (OR = 1.9; 95% CI: 1.02–3.7) or radiation plus tamoxifen (OR = 1.9; 95% CI: 1.1–3.2) were significantly more likely to report at least one new comorbid condition following breast cancer diagnosis than women who received no chemotherapy, tamoxifen or radiation. Overall, women who received adjuvant therapy were more likely to have new comorbidities. Conclusions  Comorbidities were not substantially different in breast cancer patients than the non-cancer matched controls. Future research should focus on efforts to minimize comorbidities related to chemotherapy and other combination therapy. Funding source  N01-PC-35139, N01-PC-35142, N01-PC-35138     

Screening practices in cancer survivors

Introduction  Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Little is known, however, about survivors’ screening practices for other cancers. The purpose of this study was to examine the impact of a cancer diagnosis on survivors’ screening beliefs and practices compared to those without a cancer history. Materials and methods  This study examined cancer survivors’ (n = 619) screening beliefs and practices compared to those without cancer (n = 2,141) using the National Cancer Institute’s 2003 Health Information National Trends Survey (HINTS). Results  The typical participant was Caucasian, employed, married, and female with at least a high school education, having a regular health care provider and health insurance. Being a cancer survivor was significantly associated with screening for colorectal cancer but not for breast or prostate cancer screening. Screening adherence exceeded American Cancer Society recommendations, national prevalence data, and Healthy People 2010 goals for individual tests for both groups. Physician recommendations were associated with a higher level of screening but recommendations varied (highest for breast cancer and lowest for colorectal cancer screening). Conclusions  Cancer survivors had different health beliefs and risk perceptions for screening compared to the NoCancer group. While there were no differences between survivors’ screening for breast and prostate cancer, survivors were more likely to screen for colorectal cancer than the comparison group. Screening adherence met or exceeded recommendations for individual tests for both cancer survivors and the comparison group. Implications for cancer survivors  Cancer survivors should continue to work with their health care providers to receive age and gender appropriate screening for many types of cancers. Screening for other cancers should also be included in cancer survivorship care plans.

Quality of non-breast cancer health maintenance among elderly breast cancer survivors.

PURPOSE: To assess the quality of preventive health care, the role of health care participation, and the patient and provider characteristics associated with high-quality care for breast cancer survivors. METHODS: We analyzed the 1997 to 1998 Medicare data of elderly women who were diagnosed with nonmetastatic breast cancer in 1991 or 1992 while living in a Survival, Epidemiology, and End Results (SEER) tumor registry area and who survived to the end of 1998 without evidence of cancer recurrence. Controls were matched for age, race, and geographic location. RESULTS: The 5,965 breast cancer survivors received more preventive services (influenza vaccination, lipid testing, cervical and colon screening, and bone densitometry) than matched controls. Among both groups, those who were younger, non-African-American, of higher socioeconomic status, living in urban areas, and receiving care in a teaching center were most likely to receive high-quality health maintenance. Those survivors who continued to see oncology specialists were more likely to receive appropriate follow-up mammography for their cancer, but those who were monitored by primary care physicians were more likely to receive all other non-cancer-related preventive services. Those who saw both types of practitioners received more of both types of services. When the control group was restricted only to women actively undergoing mammographic screening before the study period, receipt of preventive services was similar. CONCLUSION: Breast cancer survivors receive high-quality preventive services, but disparities on the basis of nonmedical factors still exist. Cancer follow-up may provide regular contact with the health system, maximizing the likelihood of receiving appropriate general medical care.     

Surveillance mammography in older breast cancer survivors: Current practice patterns and patient perceptions

IntroductionAlthough the benefits of surveillance mammography for older breast cancer survivors have not been quantified prospectively, it is unlikely that mammography provides substantial benefit (and possible that mammography is harmful) to women with limited life expectancy and a low risk for in-breast cancer events.Materials and MethodsWe identified 1268 women aged 77 and older with a history of Stage I-III breast cancer, who did not undergo bilateral mastectomy, were diagnosed with cancer at least three years prior to study entry, and who had consented to be surveyed as part of the Mayo Clinic Breast Disease Registry. We mailed them a one-time survey asking about their experiences with surveillance mammography. Women with metastatic disease were excluded. The primary endpoint was whether or not women reported at least one mammogram since breast cancer surgery.ResultsEight hundred forty-six of 1268 (67%) returned the survey, 734 of whom were eligible for analysis. The median age at the time of survey was 82, and the median time since cancer diagnosis was 12 years. Ninety-three percent reported having had at least one mammogram since their initial breast cancer surgery. Seventy-nine percent reported that they had surveillance mammography annually over the prior three years, including 76% of the 491 aged 80+ and 64% of the 189 aged 85 + .DiscussionMost older breast cancer survivors who have residual breast tissue are undergoing annual mammograms. Additional educational materials may be beneficial for patients and clinicians to better individualize plans for surveillance mammography in older breast cancer survivors.     

Adherence to surveillance care guidelines after breast and colorectal cancer treatment with curative intent

BACKGROUND:

Evidence‐based guidelines recommend routine surveillance, including office visits and testing, to detect new and recurrent disease among survivors of breast and colorectal cancer. The extent to which surveillance practice is consistent with guideline recommendations or may vary by age is not known.

METHODS:

Cohorts of adult patients diagnosed with breast (n = 6205) and colorectal (n = 2297) cancer between 2000 and 2008 and treated with curative intent in 4 geographically diverse managed care environments were identified via tumor registries. Kaplan‐Meier estimates were used to describe time to initial and subsequent receipt of surveillance services. Cox proportional hazards models evaluated the relation between patient characteristics and receipt of metastatic screening.

RESULTS:

Within 18 months of treatment, 87.2% of breast cancer survivors received recommended mammograms, with significantly higher rates noted for patients aged 50 years to 65 years. Among survivors of colorectal cancer, only 55.0% received recommended colon examinations, with significantly lower rates for those aged ≥ 75 years. The majority of breast (64.7%) and colorectal (73.3%) cancer survivors received nonrecommended metastatic disease testing. In patients with breast cancer, factors associated with metastatic disease testing include white race (hazards ratio [HR], 1.13), comorbidities (HR, 1.17), and younger age (HR, 1.13; 1.15; 1.13 for age groups: <50, 50–64, and 65–74 respectively). In those with colorectal cancer, these factors included younger age (HR, 1.31; 1.25 for age groups: <50 and 50–64 respectively) and comorbidities (HR, 1.10).

CONCLUSIONS:

Among an insured population, wide variation regarding the use of surveillance care was found by age and relative to guideline recommendations. Breast cancer survivors were found to have high rates of both guideline‐recommended recurrence testing and non–guideline‐recommended metastatic testing. Only approximately 50% of colorectal cancer survivors received recommended tests but greater than 67% received metastatic testing. Cancer 2012. © 2012 American Cancer Society.     

Prevalence of Cancer Visits by Physician Specialty, 1997–2006

Understanding the prevalence of cancer-related visits by physician specialty may help target educational and quality improvement initiatives. Using the 1997–2006 National Ambulatory Medical Care Survey, adult ambulatory visits (N = 161,278) were classified by cancer diagnosis and patients’ characteristics and compared with physician specialty. The prevalence of cancer visits within each specialty varied from 0% to 62%. Aside from hematology/oncology (hem/onc) specialties, nine surgical specialties and four medical specialties had more than 1% cancer visits. Cancer patients with private insurance or Medicaid coverage were less likely to see hem/onc specialists compared to Medicare patients. Whereas hem/onc specialists primarily see cancer patients, general surgeons and primary care physicians provide a large amount of cancer services, particularly to underinsured patients. Thus, when trying to contact cancer patients or their physicians, health administrators, researchers, and practitioners should consider targeting general surgeons and primary care physicians in addition to hem/onc specialists.     

Healthcare providers' discussions of physical activity with older survivors of cancer: Potential missed opportunities for health promotion

ObjectivesPhysical activity (PA) promotes physical functioning and health-related quality of life in older survivors of cancer. Using a population-based sample of Medicare Advantage beneficiaries, we aimed to characterize the survivors who reported discussing PA with their healthcare provider.Materials and MethodsData from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was linked with the 2008–2014 Medicare Health Outcomes Survey (MHOS). Older survivors diagnosed with localized- or regional-stage female breast, prostate, or colorectal cancer ≥24 months prior to survey and had visited a healthcare provider in the previous year were included in the multiple logistic regression model. Best-fitting models were identified using the Hosmer and Lemeshow Goodness-of-Fit test.ResultsThe final sample (N = 5630) included 3006 survivors who reported discussing PA and 2624 survivors who did not report discussing PA. Older survivors of cancer were significantly more likely to report discussing PA if they had a history of cardiovascular disease (p < .001), diabetes (p < .001), or musculoskeletal disease (p < .001); had a history of fall(s) in the previous twelve months (p = .003); or were obese (p < .001).DiscussionPA is an important aspect of the management of cancer, other comorbid conditions, and maintenance of physical functioning in older adulthood. The results suggest that PA discussions are not occurring consistently across survivors, and key opportunities for health promotion are being missed. Future work should identify ways to encourage these conversations in all cancer follow-up appointments.     

Preventive care receipt and office visit use among breast and colorectal cancer survivors relative to age- and gender-matched cancer-free controls

Purpose

We compare breast and colorectal cancer survivors’ annual receipt of preventive care and office visits to that of age- and gender-matched cancer-free controls.

Methods

Automated data, including tumor registries, were used to identify insured individuals aged 50+ at the time of breast or colorectal cancer diagnosis between 2000 and 2008 as well as cancer-free controls receiving care from four integrated delivery systems. Those with metastatic or un-staged disease, or a prior cancer diagnosis were excluded. Annual visits to primary care, oncology, and surgery as well as receipt of mammography, colorectal cancer, Papanicolaou, bone densitometry, and cholesterol screening were observed for 5 years. We used generalized estimating equations that accounted for repeated observations over time per person to test annual service use differences by cancer survivor/cancer-free control status and whether survivor/cancer-free status associations were moderated by patient age <65 years and calendar year of diagnosis.

Results

A total of 3743 breast and 1530 colorectal cancer survivors were identified, representing 12,923 and 5103 patient-years of follow-up, respectively. Compared to cancer-free controls, breast and colorectal cancer survivors were equally or more likely to use all types of office visits and to receive cancer screenings and bone densitometry testing. Both breast and colorectal cancer survivors were less likely than cancer-free controls to receive cholesterol testing, regardless of age, year of diagnosis, or use of primary care.

Implications for Cancer Survivors

Programs targeting cancer survivors may benefit from addressing a broad range of primary preventive care needs, including recommended cardiovascular disease screening.

     

Non-cancer adverse health conditions and perceived health and function among cancer survivors participating in a community-based cohort study in Washington County, Maryland

Introduction This study was conducted in an ongoing community-based cohort study to examine the prevalence of non-cancer adverse health conditions among cancer survivors and the association of these conditions with self-rated health and functional status. Methods Data were analyzed from CLUE II, a community-based cohort study in Washington County, Maryland that began in 1989. Cross-sectional comparisons were made between 1,261 cancer survivors and 1,261 age- and gender-matched individuals without a history of cancer. Information on non-cancer adverse health conditions, self-rated health, and activities of daily living was based on self-report. Results Compared to individuals without a history of cancer, cancer survivors were significantly more likely to report a diagnosis of cardiovascular disease (33.8% versus 29.8%; p = 0.009) and endocrine disease (other than diabetes) (17.0% versus 14.3%; p = 0.02). Further, cancer survivors reporting two or more non-cancer adverse health conditions had a greater likelihood of reporting fair or poor self-rated health (odds ratio (OR) 4.11; 95% confidence interval (95% CI) 3.06, 5.54), and difficulty with at least one activity of daily living (OR 6.03; 95% CI 4.01, 9.05) compared to cancer survivors who did not report other adverse health conditions. Discussions/Conclusions Findings from this cross-sectional data analysis indicate that cancer survivors are at increased risk for non-cancer adverse health conditions, which are associated with poorer self-rated health, more interference with normal activities, and functional limitations. Implications for Cancer Survivors Increased attention must be given to the preventive care and treatment of non-cancer adverse health conditions among cancer survivors to decrease non-cancer morbidity and mortality and to maintain and improve quality of life.