Preventive care for breast cancer survivors versus controls: Changes between 1998 and 2002

Abstract

6501 Background: Whether the recent focus on appropriate preventive care for cancer survivors has led to improvements is unclear. Methods: We used the SEER-Medicare database to examine 5 cohorts of stage 1–3 breast cancer survivors aged 65+ diagnosed between 1998 and 2002 and in fee-for-service Medicare. For each cohort (defined by diagnosis year), we calculated the mean number of visits to oncology specialists, primary care providers (PCPs), and other physicians and the percentage receiving flu shots, cholesterol screening, colorectal cancer (CRC) screening, and bone densitometry during survivorship Year 1 (days 366–730 post-diagnosis). Survivors' patterns of physician visits and preventive care were compared to 5 non-cancer control cohorts matched on age, sex, race, and region. We assessed trends over time in physician visits and preventive care using Poisson and logistic regression, respectively, adjusting for subject characteristics. Results: 23,731 survivors were matched with 23,731 controls. Over time, survivor visits to all provider types increased, but only PCP visits increased for controls (all p<.0001) (Table). Between 1998 and 2002, survivors had increases in flu shots (51.7% to 55.4%), cholesterol screening (31.0% to 38.6%), and bone densitometry (14.1% to 18.2%) (all p<.0001) but a decrease in CRC screening (29.3% to 26.9%; p=.03). Controls had increases in flu shots (61.0% to 62.7%) and cholesterol screening (38.6% to 43.7%) but a decrease in CRC screening (35.4% to 28.4%) (all p<.001). The increase over time in cholesterol screening and bone densitometry was significantly greater for survivors vs. controls (p=.02 and p<.0001, respectively). The decrease over time in CRC screening was significantly greater for controls vs. survivors (p=.003). With one exception, fewer survivors received each preventive service than controls each year. Conclusions: While rates of several preventive services have improved for survivors, they still lag behind controls in receipt of appropriate preventive care. Observed Mean (SD) Number of Physician Visits 1998 Cohort (n=2526) 1999 Cohort (n=2695) 2000 Cohort (n=5663) 2001 Cohort (n=6226) 2002 Cohort (n=6621) Adjusted P-Value for Trend over Time Adjusted P-Value for Difference in Trend over Time Between Groups Oncology Specialist Survivors 2.2 (2.5) 2.2 (2.4) 2.5 (2.6) 2.5 (2.6) 2.5 (2.8) <.0001 NA Primary Care Provider Survivors 4.2 (4.6) 4.3 (4.3) 4.2 (4.4) 4.2 (4.4) 4.3 (4.6) <.0001 0.17 Controls 3.8 (4.0) 4.0 (4.5) 3.7 (4.2) 3.6 (4.1) 3.9 (4.4) <.0001 Other Physician Survivors 3.2 (4.5) 3.4 (4.5) 3.7 (4.7) 3.6 (4.7) 3.8 (4.8) <.0001 0.002 Controls 3.6 (4.9) 3.5 (4.5) 4.0 (5.1) 3.8 (5.0) 3.7 (4.9) 0.99 Sample sizes equal for survivors and controls; Adjusted for age, race, comorbidity, region (and stage for survivors) No significant financial relationships to disclose.