The journey from cancer patient to cancer survivor: A 5-year longitudinal study

Abstract

6501 Background: The appropriate care for cancer survivors after active treatment ends is unclear. This study explores the mix of physician specialties survivors see and how this mix affects their receipt of preventive care. Methods: We conducted a retrospective, longitudinal cohort study of stage 1–3 colorectal cancer survivors age 65+ diagnosed in 1997. The cohort was followed for a 5-year survivorship period, starting 365 days after diagnosis. Using the SEER-Medicare database, we examined physician visits and preventive care services for each year during the five year survivorship period. We investigated how receipt of preventive services relates to the mix of physician specialties seen: primary care provider (PCP) only, oncologist only, both PCP and oncologist, neither PCP nor oncologist. Results: 1,541 patients met the eligibility criteria (mean age 76, 43% male, 85% White). Over the five years of survivorship, the mean numbers of PCP visits increased (4.2, 4.1, 4.5, 4.6, 4.7) while the mean number of oncology visits decreased (1.3, 1.0, 0.8, 0.7, 0.5). In year 1 of survivorship, 37% of patients saw both a PCP and oncologist, 44% only a PCP, and 8% only an oncologist. By year 5, the respective numbers were 21%, 62%, and 4%. The rates of cholesterol screening (33%), mammography (43%), and cervical cancer screening (19%) were highest during the first year of survivorship. Compared to patients who saw only a PCP, only an oncologist, or neither, patients who had visits to both a PCP and oncologist were more likely to get flu shots, cholesterol screening, mammograms, cervical cancer screening, and bone densitometry (all p<.0001). Conclusions: The mix of providers seen and preventive care received evolves during the first 5 years of survivorship. As shared care between PCPs and oncologists shifts to care by PCPs only, the rate of preventive care drops, particularly for cancer screenings. These results support the need for a survivorship care plan that explicitly outlines the roles of PCPs and oncologists and ensures proper preventive care. No significant financial relationships to disclose. [Table: see text]