Healthcare Utilization in Cancer Survivors: Six-month Longitudinal Cohort Data.
Open AccessBackground:The growing number of cancer survivors in the US underscores the need for survivorship services. Cancer survivors are at higher risk for recurrence, as well as comorbidities and a lower quality of life. Understanding patterns of healthcare utilization by cancer survivors after treatment completion and prevalence of delaying medical care may help inform healthcare delivery to cancer survivors.Methods:Baseline (n=991) and 6-month follow up data (n=777) was collected among breast, prostate, and colorectal cancer survivors who had completed curative treatment from 32 cancer centers across the US. We categorized the 32 centers into one of three cancer survivorship care models: specialized consultative, longitudinal, and oncology embedded. Participants completed surveys on their healthcare utilization including number of visits to different types of providers and reasons for delaying medical care if applicable. We then categorized participants as high or low users based on median number of visits. Chi-squared values were calculated to estimate differences by healthcare utilization category. Logistic regression models were generated to examine factors that may predict high health care utilization or delay of medical care.Results:On average, survivors in this cohort made 13.2 visits to healthcare providers over six months. High healthcare users, categorized as those who reported over 10 visits (median value), were more likely than low users to be female (92% vs. 83%, p<0.0001), have a lower income (21% vs. 13%, p<0.05), report breast cancer diagnosis (89% vs. 81%, p<0.0001), and have a higher cancer stage at diagnosis (14% vs. 9% reporting stage 3 or 4, p<0.001). Low healthcare users were more likely to be married or living with their partner (74% vs. 62%, p<0.01). There were no significant differences in rates of delaying medical care across survivorship care models. A higher quality of life score strongly predicted high healthcare utilization (OR=2.73, CI=1.9-3.9) and delay of medical care (OR=1.74, CI=1.2-2.6). High healthcare utilization was also predicted by having <1.5 years since diagnosis (OR=1.47, 1.0-2.1) or being divorced or separated from partner (OR=1.48, CI=1.1-2.1). Colorectal cancer survivors had higher rates of healthcare utilization (OR=3.65, CI=0.9-14.8). Delay of medical care was further predicted by lower levels of self-efficacy (OR=0.62, CI=0.5-0.8) and education (OR=1.83, CI=1.1-3.0) for participants with 4-year college degrees compared to those with HS/GED or less.Conclusions:Our findings reveal factors that are associated with high healthcare utilization among cancer survivors such as quality of life, marital status, and time since diagnosis. Low self-efficacy was a strong predictor of delaying medical care. This research will contribute to cancer care delivery research and inform healthcare planning.
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Gonzalez_gwu_0075M_15130.pdf | 2020-05-15 | Open Access |
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