Abstract
Rising demand on cancer system resources, alongside mounting evidence that demonstrates the safety and acceptability of primary care-led follow-up care, has resulted in some cancer centres discharging patients back to primary care after treatment. At the same time, the ways in which routine cancer follow-up care is provided across Canada continue to vary widely. The objectives of the present study were to investigate patterns of routine follow-up care at a cancer centre for breast, colorectal, gynecologic, and prostate cancer survivors; factors associated with receipt of follow-up care at a cancer centre; and changes in follow-up care at a cancer centre over time. We identified all people diagnosed in Nova Scotia with an invasive breast, colorectal, gynecologic, or prostate cancer between 1 January 2006 and 31 December 2013. We linked the resulting population-based dataset, at the patient level, to cancer centre or clinic data and to census data. We identified a nonmetastatic survivor cohort (n = 12,267) and developed decision rules to differentiate routine from non-routine visits during the follow-up care period (commencing 1 year after diagnosis). Descriptive statistics were computed to describe the patterns of routine follow-up care at a cancer centre. Negative binomial regression was used to examine factors associated with visits made and changes over time. Nearly half the survivors (48.4%) had at least 1 follow-up visit to the cancer centre, with variation by disease site (range: 30.2%-62.4%). Disease site and stage at diagnosis were associated with receipt of follow-up care at a cancer centre. For instance, compared with breast cancer survivors, survivors of gynecologic cancer had more visits [incidence rate ratio (irr): 1.48; 95% confidence interval (ci): 1.34 to 1.64], and survivors of colorectal cancer had fewer visits (irr: 0.45; 95% ci: 0.40 to 0.51). Year of diagnosis was associated with follow-up at a cancer centre, with each successive calendar year being associated with an 8% increase in visits made (irr: 1.08; 95% ci: 1.07 to 1.10). Despite evidence that follow-up care can be effectively and safely delivered in primary care, and despite intensifying demands on oncology services, many survivors continue to receive routine follow-up care at a cancer centre.
Highlights
Rising demand on cancer system resources, alongside mounting evidence that demonstrates the safety and acceptability of primary care–led follow-up care, has resulted in some cancer centres discharging patients back to primary care after treatment
This retrospective cohort study used linked administrative health data to examine routine follow-up visits to specialist cancer centres and clinics for all persons diagnosed in Nova Scotia with nonmetastatic breast, prostate, colorectal, or gynecologic cancer over an 8-year period
We investigated patterns of routine follow-up visits received by breast, colorectal, gynecologic, and prostate cancer survivors at cancer centres in Nova Scotia
Summary
Rising demand on cancer system resources, alongside mounting evidence that demonstrates the safety and acceptability of primary care–led follow-up care, has resulted in some cancer centres discharging patients back to primary care after treatment. The prevalence of cancer survivors is rapidly growing[1]: Considering all cancer types, two thirds of individuals diagnosed with cancer today will be long-term survivors, meaning that they will live for 5 years or more after diagnosis. For those patients, routine follow-up care marks the transition from intensive treatment to long-term survivorship[2]. As long-term survivors, those individuals require routine follow-up to detect disease recurrence or new primary cancers, to prevent and manage the late effects of the cancer and its treatment, to manage pre-existing chronic conditions, and to address general preventive care needs. Together with a mounting evidence base showing that primary care–led follow-up is a safe and acceptable alternative to oncology-led care[7,8,9], has resulted in some cancer centres transfering routine follow-up care back to a patient’s primary care provider (pcp) after treatment[10]
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