Abstract
Simple SummaryWe conducted a survey to identify the key aspects that influence cancer care for racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. New Mexico is a large state with many ethnic and racially diverse communities who reside in rural areas. Data obtained through our New Mexico Tumor Registry show that these patients often have different and worse cancer health outcomes. To learn more about how to improve their care, we surveyed patients regarding their access to primary care (PC); compliance with screening recommendations; treatment for conditions other than cancer (e.g., diabetes, obesity, heart problems, etc.); difficulties attending their clinic visits; and whether or not they received information about their survivorship care in the form of a survivorship care document (SCD). We found that the majority of the 150 patients surveyed reported having a Primary Care Provider (PCP). Many had health complications other than cancer, those who resided in rural areas had more difficulties getting to their cancer follow-up appointments, and nearly half had not received SCDs. We used these survey results to develop an oncology/PCP care coordination intervention to improve the oncology and cancer survivorship care for those who were at low risk of recurrence.We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients’ access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.
Highlights
As the population in the United States (U.S.) grows, diversifies, and lives longer, the number of cancer survivors is expected to increase from 15.5 million (2016) to an estimated 20.3 million by 2026 [1]
Data from rural residents (n = 39). Those from urban areas traveling in excess of 30 miles (n = 13) were presented together, as response patterns consistently demonstrated patient barriers stemming from the distance travelled and access to care
Data derived from the New Mexico Tumor Registry demonstrates that while non-Hispanic White women in New Mexico have the highest rates of breast cancer in the state, over the past four decades the incidence of breast cancer has steadily increased in Hispanic and American Indian women, and these women present with higher stages of disease and have poorer overall survival rates [26]
Summary
As the population in the United States (U.S.) grows, diversifies, and lives longer, the number of cancer survivors is expected to increase from 15.5 million (2016) to an estimated 20.3 million by 2026 [1]. Cancer survivors require surveillance for recurrent and subsequent malignancies, management of long-term and late effects of cancer treatment, consistent care to address high rates of comorbid conditions, health promotion, and care coordination [1,2,3,4] Such cancer follow-up care is provided inequitably across cancer survivor populations. A recent national cross-sectional survey shows that upon completion of cancer treatment, patients, in rural and underserved areas, experience unmet physical and psychosocial needs across sixteen survivorship domains, as well as suboptimal rates of preventive and cancer surveillance screening In response to this looming crisis in cancer care delivery, the American Society of Clinical Oncology (ASCO) drew on a pivotal 2005 Institutes of Medicine (IOM) report [3], proposing a multifaceted strategy to redesign service delivery models by expanding the role of primary care providers (PCPs) in follow-up cancer care [8]. No evidence-based models for care coordination exist to assist providers seeking to integrate oncology and primary care for their patients [9,10,11,12,13,14,15]
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