The use of preventive health services among elderly uterine cancer survivors

doi:10.1016/j.ajog.2007.05.036

American Journal of Obstetrics and Gynecology

Volume 198, Issue 1, January 2008, Pages 86.e1-86.e8

Presentations of preliminary findings made at the 12th Hong Kong International Cancer Congress, Hong Kong, People’s Republic of China, Dec. 8-10, 2005, and as abstract 6045, 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

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Objective

The purpose of the study was to determine whether women who survived uterine cancer received 4 recommended preventive services (mammography, colorectal cancer screening, influenza immunization, and bone density testing) at the same rates as women with no history of cancer.

Study Design

We used the Surveillance, Epidemiology, and End Results–Medicare database to compare the rates among survivors aged 67 years or older with a matched group of women with no history of cancer.

Results

Survivors were significantly more likely to have a mammogram (adjusted odds ratio [OR], 1.40; 95% confidence interval [CI], 1.30-1.50) or a colorectal cancer screening examination (adjusted OR, 1.11; 95% CI, 1.05-1.18). Influenza immunization and bone density testing rates were similar. The 28% of survivors seen by an obstetrician-gynecologist or gynecologic oncologist had the highest rates of use.

Conclusion

Efforts need to be made to increase the use of services by all women to achieve the target rates established by Healthy People 2010.

Section snippets

Materials and Methods

We used SEER-Medicare data files from the 2003 merge, in which 97% of the SEER subjects 65 years of age or older were linked to Medicare data.¹⁰ These files contain information on cancer cases diagnosed from 1973-1999 and Medicare data through 2002. Uterine cancer patients were identified using the SEER site recode variable for uterine cancer (corpus and not otherwise specified; n = 63,613). Of the women diagnosed from 1973-1993 (n = 44,981), we accepted 38,231 women: those who had in situ (n =

Results

The distributions of the characteristics of the cancer survivors, and those with no history of cancer, shown in Table 1, demonstrate the improved balance in the independent variables obtained through the propensity score matching. Approximately 28% of women had seen an obstetrician-gynecologist or gynecologic oncologist.

The age-adjusted rates (Table 2) showed that women who survived uterine cancer were more likely than women with no history of cancer to have mammography or colorectal cancer

Comment

The good news is that women who survived 5 years or longer after the diagnosis of uterine cancer had preventive health service utilization rates that were significantly greater than the rates among women with no history of cancer for 2 of the services we measured and equal rates for 2. Unfortunately, the rates among the survivors for mammography (56.0%), colon cancer screening (21.2%), and influenza vaccination (52.7%) were well below the national targets set in Healthy People 2010 of 70%, 50%,

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Cited by (22)

Access to preventive health care for cancer survivors
2013, American Journal of Preventive Medicine
Citation Excerpt :
Some15–17 report less preventive services use by cancer survivors, whereas others14,16,18 report greater use. Most studies15,17,21 reporting less preventive services use were conducted in cohorts of elderly Medicare beneficiaries at similar times since diagnosis, using the linked SEER-Medicare data. Studies14,18–20 reporting similar or greater preventive services use were conducted in samples of prevalent survivors of all ages and cancer types, with all types of health insurance (including the uninsured), and a range of times since diagnosis.
Access to health care, particularly effective primary and secondary preventive care, is critical for cancer survivors, in order to minimize the adverse sequelae of cancer and its treatment.
The goal of the study was to evaluate the association between cancer survivorship and access to primary and preventive health care.
Cancer survivors (n=4960) and individuals without a cancer history (n=64,431) aged ≥18 years, from the 2008–2010 Medical Expenditure Panel Survey (MEPS), were evaluated. Multiple measures of access and preventive services use were compared. The association between cancer survivorship and access and preventive services was evaluated with multivariate logistic regression models, stratified by age group (18–64 years and ≥65 years), controlling for the effects of age, gender, race/ethnicity, education, marital status, and comorbidities. Data were analyzed in 2013.
Cancer survivors aged ≥65 years had equivalent or greater access and preventive services use than individuals without a cancer history, in adjusted analyses. However, among those aged 18–64 years with private health insurance, cancer survivors were more likely than other individuals to have a usual source of care and to use preventive services, whereas uninsured or publicly insured cancer survivors were generally less likely to have a usual source of care and to use preventive services than were uninsured or publicly insured adults without a cancer history.
Although access and preventive care use in cancer survivors is generally equivalent or greater compared to that of other individuals, disparities for uninsured and publicly insured cancer survivors aged 18–64 years suggest that improvements in survivor care are needed.
Influenza Vaccination Among Individuals with Cancer and Their Family Members
2010, American Journal of Preventive Medicine
Citation Excerpt :
The proportion of elderly patients found to be receiving vaccinations (78%) was higher than that reported in the literature. Using the SEER-Medicare data, one study11 reported that among elderly patients with advanced colorectal cancer, the percentage receiving vaccinations had increased from 26% in 1993 to 43% in 1998, whereas another study20 found that approximately 53% of elderly survivors of uterine cancer had been vaccinated for influenza in 1999. In addition, one study17 used four panels of MEPS data (2000–2004) to examine the use of preventive health services among patients with cancer and reported that 54% had been vaccinated.
Influenza vaccination for family members of patients with cancer lowers patients' risk of influenza and related complications.
This study aims to examine the utilization of influenza vaccination among such families.
Individuals directly or indirectly affected by cancer and a cancer-free control group were identified from the 2005 and 2006 Medical Expenditure Panel Survey: current patients (CURR-I) and their family members (CURR-F); previous patients (PREV-I) and family members (PREV-F); and individuals in families not affected by cancer (I-F). Logistic regressions with appropriate weighting algorithms for survey data were performed to compare utilization among these five groups, while controlling for confounding factors (e.g., demographics, SES).
The proportion of those vaccinated was substantially higher among patients with cancer. It was 58.7%, 54.7%, 43.83%, 39.73%, and 29.3% for CURR-I, PREV-I, CURR-F, PREV-F, and I-F, respectively. A similar pattern was observed in analyses stratified by age groups (18–49, 50–64, and ≥65 years). Results from logistic regressions indicated that the CURR-I group was significantly more likely to have influenza vaccine than I-F (OR [CI]=1.62 [1.10, 2.36]; 1.50 [1.11, 2.02]; and 1.42 [1.06, 1.92] for those aged 18–49, 50–64, and ≥65 years, respectively), but the differences between family members of patients with cancer and the control were not significant after controlling for the confounders. A significant difference between PREV-I and I-F was observed for only those aged ≥65 years (OR [CI]=1.47 [1.09, 1.99]).
Influenza vaccination was underutilized (<45%) among family members of patients with cancer. To reduce health risks for cancer survivors, prevention efforts should be extended to their family members.
Quality of care for chronic diseases in a british cohort of long-term cancer survivors
2010, Annals of Family Medicine
Citation Excerpt :
Chronic disease management is an important issue for older, long-term survivors, many of whom will have 1 or more comorbid diseases.2 Research from the United States has highlighted, however, the underuse of chronic disease monitoring in individuals with cancer.3–8 Furthermore, cancer survivors with a comorbid condition have a substantially higher likelihood of poor health and disability than those without a history of cancer.9,10
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.
A cross-sectional study of factors associated with influenza vaccination in Korean cancer survivors
2021, European Journal of Cancer Care
Understanding Long-Term Cancer Survivors’ Preferences for Ongoing Medical Care
2019, Journal of General Internal Medicine
Racial and socioeconomic disparities in adherence to preventive health services for ovarian cancer survivors
2019, Journal of Cancer Survivorship

View all citing articles on Scopus

Cite this article as: McBean AM, Yu X, Virnig BA. The use of preventive health services among elderly uterine cancer survivors. Am J Obstet Gynecol 2008;198;86.e1-86.e8.

This work was supported by grants from the National Institute of Aging (R01 AG 025079) and the National Cancer Institute (R01 CA 098974).

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ResearchOncologyThe use of preventive health services among elderly uterine cancer survivors

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Prev Med

Prev Med

J Clin Epidemiol

Am J Obstet Gynecol

Am J Prev Med

The pre-therapeutic classification of co-morbidity in chronic disease

J Chron Dis

Competing demands of primary care: a model for the delivery of clinical preventive services

J Fam Pract

The delivery of preventive services in primary care practices according to chronic status

Am J Public Health

Chronic disease as a barrier to breast and cervical cancer screening

J Gen Intern Med

Quality of non-breast cancer health maintenance among elderly breast cancer survivors

J Clin Oncol

Under use of necessary care among cancer survivors

Cancer

Potential for cancer related health services research using a linked Medicare-tumor registry database

Medical Care

Research
Oncology
The use of preventive health services among elderly uterine cancer survivors