Quality of Care for Chronic Diseases in a British Cohort of Long-Term Cancer Survivors

Abstract

Previous research has shown that long-term cancer survivors with other chronic diseases may receive poorer care for those diseases compared with the general population. We sought to establish the quality of care for chronic diseases among cancer survivors in the United Kingdom. From the UK General Practice Research Database, we identified 21,366 adult patients who had survived 5 or more years after a diagnosis of breast, colorectal, or prostate cancer with a diagnosis of hypertension, coronary artery disease, diabetes, or cerebrovascular disease. For each patient, an age-sex matched noncancer control patient was selected from the same general practice and with the same chronic disease. We compared the chronic disease care in cancer survivors and their matched controls. The proportion of patients meeting quality standards for chronic disease care was high in both cancer survivors and control patients. Although cancer survivors were slightly less likely to receive blood pressure monitoring and cholesterol tests, this difference was no longer apparent if patients who died during the study period were excluded. For instance, 93% of breast cancer survivors received blood pressure monitoring compared with 94% of matched control patients. Similarly, control of disease was comparable among all patients, with the exception of diabetic prostate cancer survivors, who had fewer cholesterol readings under the control limit (17% reduction, 95% CI, 7%-26%) and diabetic colorectal survivors, who had fewer calendar quarters of glycated hemoglobin control (12% reduction, 95% CI, 2%-23%). Care of comorbidities is not neglected in the United Kingdom because people have had a previous diagnosis of cancer. One explanation is that in the United Kingdom, such care is provided through a robust primary care system.