Growth curve analysis of BMI in relation to primary care utilization in prostate cancer survivors

Abstract

Cancer survivors are advised to maintain a healthy BMI to optimize quality of life. In the VA healthcare system, multidisciplinary primary care clinics are responsible for screening and management of overweight or obesity, but it is unclear if cancer survivors are accessing or benefiting from these services. This study aimed to determine if primary care utilization was associated with changes in BMI of prostate cancer survivors, a group with very high rates of long-term survival. Data on demographics, comorbidities, cancer treatment, body size, and number of primary care encounters (medical, behavioral health, nutrition, and weight management program) were collected from electronic medical records and the local tumor registry for 406 early stage prostate cancer survivors who were overweight or obese at diagnosis. Growth curve modeling assessed BMI trajectories in relation to primary care utilization. Results indicated that survivors averaged 18 primary care encounters over the observation period but rarely accessed behavioral health, nutrition, or weight management program services. The average BMI trajectory was non-linear, showing an increase in BMI until 3.2 years after diagnosis followed by deceleration. Primary care utilization was inversely associated with BMI growth, (β = -0.05, p < 0.01). This association was not impacted by demographic, cancer treatment, or comorbidities. Although primary medical care encounters were associated with modest reductions in BMI, overweight or obese prostate cancer survivors appear to be underutilizing the full range of primary care services that could address the motivational, informational, dietary, and physical activity barriers associated with weight loss.: