Follow-up Care of Underserved Breast Cancer Survivors
Follow-up Care of Underserved Breast Cancer Survivors
Purpose: To investigate the impact of the involvement of primary care physicians (PCPs) on the receipt of preventive follow-up care after a breast cancer (BC) diagnosis among a low-income population.
Methods: Multiple logistic regression analyses were performed to identify potential factors associated with receipt of preventive care among 579 low-income women with BC. The main outcome variables at 36 months after BC diagnosis were receipt of annual mammography, Papanicolaou smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old. The main independent variable was type of provider visit in the past 12 months.
Results: Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (adjusted odds ratio [AOR], 2.67; P = .109 and AOR, 2.20, P = .0008, respectively), a Papanicolaou smear in the past 2 years (AOR, 2.90; P = .04 and AOR, 2.24, P = .009, respectively), and colonoscopy (AOR, 2.99; P = .041 and AOR, 2.17; P = .026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds ratio of receiving each clinical care service.
Conclusions: The involvement of PCPs in the medical care of low-income BC survivors results in better preventive follow-up care. Getting PCPs involved in the care of cancer survivors might be particularly pertinent for low-income populations because of lower costs and ease of access compared with cancer specialist-provided care.
Early detection and improved treatment have dramatically increased the life expectancy of women with breast cancer (BC), leading to overall 5-year survival rates of 98% for local-stage disease and 84% for regional-stage disease. Women with BC now represent the largest female cancer survivor group in the United States. This is creating new challenges for the health care system, with medical concern shifting from initial treatment to survivorship and the responsibility for care shifting from oncologists to primary care providers.
Long-term BC survivors are at an increased risk of developing a second primary cancer or recurrent disease in the affected breast, which makes follow-up care an essential part of cancer survivorship.5– Cancer patients traditionally tend to visit their oncologists for routine follow-up after completing cancer treatments. However, with the increased populations of patients with newly diagnosed breast cancer and cancer survivors, there is concern about the capacity for oncologists to provide appropriate care and meet the needs of cancer patients in the future. In addition, there is concern about possible deficiencies in non-cancer-related care that cancer survivors receive from oncologists because oncologists may be too focused on cancer-specific issues and overlook other primary care services.
In recognition of the importance of the involvement of primary care physicians (PCPs) in ongoing cancer care, the American Society of Clinical Oncology published guidelines for BC survivors, suggesting that PCPs take greater responsibility for survivorship care. This highlights the need for better information about the participation of PCPs in BC survivorship care, yet research in this area is limited.
There are a handful of studies that compare the follow-up care provided by PCPs to that provided by oncologists for breast cancer survivors. Results of these studies showed no difference in recurrence detection outcomes or receipt of preventive care between survivors followed up by PCPs and survivors followed up by oncologists. Another study reported PCP-centered follow-up is superior to oncologist-centered follow-up in terms of recommended preventive care. However, these studies have limitations, including sample populations that were either restricted to certain age groups, living in areas outside of the United States, or insured by Medicare. It is important to note that none of these studies examined follow-up care among medically underserved, low-income, and/or uninsured women.
The unequal distribution of the financial burden of breast cancer across socioeconomic groups has been well documented, and low-income, less educated women may be at particular risk for poorer survivorship care because of financial hardship and poor access to medical care. An examination of PCPs' involvement in survivorship care among low-income women may assist in identifying effective and cost-efficient ways to deliver optimal care among vulnerable BC patient populations.
The objective of this study was to identify potential factors associated with receipt of appropriate follow-up care among low-income, medically underserved women with BC, in particular with regard to preventive services. This is the first such study performed in a low-income population of women with BC. We were specifically interested in investigating the effect of PCPs' involvement in the receipt of follow-up care.
Abstract and Introduction
Abstract
Purpose: To investigate the impact of the involvement of primary care physicians (PCPs) on the receipt of preventive follow-up care after a breast cancer (BC) diagnosis among a low-income population.
Methods: Multiple logistic regression analyses were performed to identify potential factors associated with receipt of preventive care among 579 low-income women with BC. The main outcome variables at 36 months after BC diagnosis were receipt of annual mammography, Papanicolaou smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old. The main independent variable was type of provider visit in the past 12 months.
Results: Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (adjusted odds ratio [AOR], 2.67; P = .109 and AOR, 2.20, P = .0008, respectively), a Papanicolaou smear in the past 2 years (AOR, 2.90; P = .04 and AOR, 2.24, P = .009, respectively), and colonoscopy (AOR, 2.99; P = .041 and AOR, 2.17; P = .026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds ratio of receiving each clinical care service.
Conclusions: The involvement of PCPs in the medical care of low-income BC survivors results in better preventive follow-up care. Getting PCPs involved in the care of cancer survivors might be particularly pertinent for low-income populations because of lower costs and ease of access compared with cancer specialist-provided care.
Introduction
Early detection and improved treatment have dramatically increased the life expectancy of women with breast cancer (BC), leading to overall 5-year survival rates of 98% for local-stage disease and 84% for regional-stage disease. Women with BC now represent the largest female cancer survivor group in the United States. This is creating new challenges for the health care system, with medical concern shifting from initial treatment to survivorship and the responsibility for care shifting from oncologists to primary care providers.
Long-term BC survivors are at an increased risk of developing a second primary cancer or recurrent disease in the affected breast, which makes follow-up care an essential part of cancer survivorship.5– Cancer patients traditionally tend to visit their oncologists for routine follow-up after completing cancer treatments. However, with the increased populations of patients with newly diagnosed breast cancer and cancer survivors, there is concern about the capacity for oncologists to provide appropriate care and meet the needs of cancer patients in the future. In addition, there is concern about possible deficiencies in non-cancer-related care that cancer survivors receive from oncologists because oncologists may be too focused on cancer-specific issues and overlook other primary care services.
In recognition of the importance of the involvement of primary care physicians (PCPs) in ongoing cancer care, the American Society of Clinical Oncology published guidelines for BC survivors, suggesting that PCPs take greater responsibility for survivorship care. This highlights the need for better information about the participation of PCPs in BC survivorship care, yet research in this area is limited.
There are a handful of studies that compare the follow-up care provided by PCPs to that provided by oncologists for breast cancer survivors. Results of these studies showed no difference in recurrence detection outcomes or receipt of preventive care between survivors followed up by PCPs and survivors followed up by oncologists. Another study reported PCP-centered follow-up is superior to oncologist-centered follow-up in terms of recommended preventive care. However, these studies have limitations, including sample populations that were either restricted to certain age groups, living in areas outside of the United States, or insured by Medicare. It is important to note that none of these studies examined follow-up care among medically underserved, low-income, and/or uninsured women.
The unequal distribution of the financial burden of breast cancer across socioeconomic groups has been well documented, and low-income, less educated women may be at particular risk for poorer survivorship care because of financial hardship and poor access to medical care. An examination of PCPs' involvement in survivorship care among low-income women may assist in identifying effective and cost-efficient ways to deliver optimal care among vulnerable BC patient populations.
The objective of this study was to identify potential factors associated with receipt of appropriate follow-up care among low-income, medically underserved women with BC, in particular with regard to preventive services. This is the first such study performed in a low-income population of women with BC. We were specifically interested in investigating the effect of PCPs' involvement in the receipt of follow-up care.
