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Preventive Care for Colorectal Cancer Survivors: A 5-Year Longitudinal Study

Claire F. Snyder, Craig C. Earle, Robert J. Herbert, Bridget A. Neville, Amanda L. Blackford, Kevin D. Frick

From the Division of General Internal Medicine, Department of Medicine; Department of Oncology, Johns Hopkins School of Medicine; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Corresponding author: Claire Snyder, PhD, Johns Hopkins School of Medicine, 624 N Broadway, Room 657, Baltimore, MD 21205; e-mail: csnyder{at}jhsph.edu

Purpose To explore the mix of physician specialties that long-term survivors visit and how the mix relates to preventive care.

Patients and Methods Using the Surveillance, Epidemiology, and End Results–Medicare database, we conducted a retrospective, longitudinal study of stage I to III Medicare fee-for-service colorectal cancer patients diagnosed in 1997. We examined physician visits and preventive care each year for 5 years, starting 366 days postdiagnosis, and how preventive service receipt related to the physician mix seen: primary care provider (PCP) only, oncologist only, both, or neither.

Results A total of 1,541 patients met the eligibility criteria (mean age, 76; 43% male; 85% white). During 5 years, PCP visits increased from a mean of 4.2 to 4.7 (P < .0001), and oncology visits decreased from 1.3 to 0.5 (P < .0001). Survivor care by PCPs only increased from 44% to 62%, whereas shared care by PCPs and oncologists dropped from 37% to 21% (P < .0001). Survivors who saw both PCPs and oncologists were most likely to receive influenza vaccination, mammograms, and cervical cancer screening; survivors who saw PCPs only were most likely to receive cholesterol screening and bone densitometry. Higher socioeconomic status was associated with increased influenza vaccination, mammograms, and cervical cancer screening (P < .05). Over time, there was a decrease in mammography and cervical cancer screening and an increase in influenza vaccination (P < .05).

Conclusion As oncologists become less involved in survivor care, cancer-related screening decreases significantly. These results support the need for survivorship care plans that explicitly outline the roles of PCPs and oncologists in sharing care for cancer survivors, and how these roles may change over time.

Supported by an unrestricted research grant from Pfizer Inc.

Presented at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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