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Curr Oncol. 2017 Apr;24(2):81-89. doi: 10.3747/co.24.3454. Epub 2017 Apr 27.

Use of physician services during the survivorship phase: a multi-province study of women diagnosed with breast cancer.

Author information

1
Cancer Outcomes Research Program, Dalhousie University and Nova Scotia Health Authority, Halifax, NS.
2
Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.
3
Epidemiology and Cancer Registry, Cancer-Care Manitoba, Winnipeg, MB.
4
Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON.
5
Cancer Control Research, BC Cancer Agency, Vancouver, BC.
6
University Health Network, Toronto, ON.
7
Cancer Care Ontario, Toronto, ON.
8
Department of Surgery, Dalhousie University, Halifax, NS.
9
University of Manitoba, Winnipeg, MB.
10
Stanford University School of Medicine, Stanford, CA, U.S.A.
11
Department of Family and Community Medicine, University of Toronto, Toronto, ON.

Abstract

INTRODUCTION:

Oncologists have traditionally been responsible for providing routine follow-up care for cancer survivors; in recent years, however, primary care providers (pcps) are taking a greater role in care during the follow-up period. In the present study, we used a longitudinal multi-province retrospective cohort study to examine how primary care and specialist care intersect in the delivery of breast cancer follow-up care.

METHODS:

Various databases (registry, clinical, and administrative) were linked in each of four provinces: British Columbia, Manitoba, Ontario, and Nova Scotia. Population-based cohorts of breast cancer survivors were identified in each province. Physician visits were identified using billings or claims data and were classified as visits to primary care (total, breast cancer-specific, and other), oncology (medical oncology, radiation oncology, and surgery), and other specialties. The mean numbers of visits by physician type and specialty, or by combinations thereof, were examined. The mean numbers of visits for each follow-up year were also examined by physician type.

RESULTS:

The results showed that many women (>64%) in each province received care from both primary care and oncology providers during the follow-up period. The mean number of breast cancer-specific visits to primary care and visits to oncology declined with each follow-up year. Interprovincial variations were observed, with greater surgeon follow-up in Nova Scotia and greater primary care follow-up in British Columbia. Provincial differences could reflect variations in policies and recommendations, relevant initiatives, and resources or infrastructure to support pcp-led follow-up care.

CONCLUSIONS:

Optimizing the role of pcps in breast cancer follow-up care might require strategies to change attitudes about pcp-led follow-up and to better support pcps in providing survivorship care.

KEYWORDS:

Breast cancer; follow-up care; primary care; survivors

Conflict of interest statement

We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

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