Continuity of Care, Follow-Up Care, and Outcomes among Breast Cancer Survivors.

Chen Chen,Hsieh Hsieh,Chung Chung

doi:10.3390/ijerph16173050

Abstract

This retrospective cohort study examined the effects of care continuity on the utilization of follow-up services and outcome of breast cancer patients (stages I–III) in the post-treatment phase of care. Propensity score matching and generalized estimation equations were used in the analysis of data obtained from national longitudinal databases. The continuity of care index (COCI) was calculated separately for primary care physicians (PCP) and oncologists. Our results revealed that breast cancer survivors with a higher oncology COCI were more likely than those with a lower oncology COCI to use mammography or breast ultrasound during the follow-up period (OR = 1.26, 95% CI: 1.19–1.32; OR = 1.12, 95% CI: 1.06–1.18; respectively). In terms of health outcomes, a higher oncology COCI was associated with a lower likelihood of hospitalization (OR = 0.78, 95% CI: 0.71–0.85) and emergency department use (OR = 0.88, 95% CI: 0.82–0.95). A higher PCP COCI was also associated with a lower likelihood of hospitalization (OR = 0.77, 95% CI: 0.70–0.85) and emergency department use (OR = 0.75, 95% CI: 0.68–0.82). Overall, this study determined that ambulatory care continuity is positively associated with the likelihood of using recommended follow-up care services and negatively associated with adverse health events among breast cancer survivors.

Highlights

Diagnosis and improvements in cancer treatment have greatly enhanced the likelihood of cancer survival, and the number of cancer survivors is expected to reach 20 million by 2026 [1]
In terms of follow-up care utilization, breast cancer survivors with a higher oncology continuity of care index (COCI) was more likely to use mammography (OR = 1.26, 95% CI: 1.19–1.32), breast ultrasound
This study examined the correlations between ambulatory continuity of care and the utilization of follow-up care by breast cancer survivors and their health outcomes

Summary

Introduction

Diagnosis and improvements in cancer treatment have greatly enhanced the likelihood of cancer survival, and the number of cancer survivors is expected to reach 20 million by 2026 [1]. Survivorship care has even been described as a paradigm shift in the cancer care continuum [3]. The follow-up period after cancer treatment is a distinct phase of care, involving psychosocial, community and supportive care, health promotion, regular monitoring, and long-term follow-up as well as interventions for late-effects [4,5,6]. Cancer care is a worldwide problem of considerable complexity and fragmentation [7,8]. The fact that treatment can have a major impact on the long-term health and quality of life of survivors greatly complicates disease management, and the disease burden of survivors is often underestimated. Regular surveillance care in accordance with established guidelines is underused [9,10]. Public Health 2019, 16, 3050; doi:10.3390/ijerph16173050 www.mdpi.com/journal/ijerph

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