Health care quality experiences among cancer survivors in the United States, 2011.

Abstract

246 Background: Recent national reports highlight gaps in the quality of health care received by the growing population of cancer survivors in the United States. A deeper understanding of the health care experiences of cancer survivors and related disparities could inform interventions designed to address these gaps. Methods: Data from the 2011 Medical Expenditures Panel Survey Household Component and Experiences with Cancer Survivorship Supplement (n=1,592) were used to compare health care experiences of survivors those those of individuals in active treatment. Logistic regression models of three outcomes (receipt of necessary care; detailed discussions with providers about late or long-term side effects of cancer treatment; and detailed discussions with providers about lifestyle or health recommendations e.g., diet, exercise, quitting smoking) were controlled for potential confounding variables including age, sex, health insurance status, education, race/ethnicity, and marital status. Survey weights were applied to account for the complex sampling design and estimates are generalizable to the US civilian, non-institutionalized population. Results: Most respondents (96%), whether or not they were in active treatment, reported they had received all medical care, tests, or treatments that they or their providers believed were necessary. Fewer survivors, compared to respondents in active treatment, reported their providers had discussed late or long-term side effects (37% versus 61%; p<0.01) or lifestyle recommendations with them in detail (57% versus 72%). These associations persisted in the multivariable models of side effect discussions (OR=0.38; 95% CI: 0.26, 0.55) and lifestyle recommendations (OR=; 95% CI: 0.35, 0.68) regardless of the length of time since treatment had finished. Subgroups with lower odds of all three outcomes included those with public or no insurance and those with lower levels of education. Conclusions: Care received after treatment for cancer may not fully address the unique needs of cancer survivors and, in particular, those with public or no insurance and with low levels of education regardless of treatment status. Targeted interventions with a focus on these subgroups may be required.