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

  • C. Kendell Dalhousie University; Nova Scotia Health Authority
  • K.M. Decker University of Manitoba; Cancer- Care Manitoba
  • P.A. Groome Queen’s University
  • M.L. McBride BC Cancer Agency
  • L. Jiang Queen’s University
  • M.K. Krzyzanowska University Health Network; Cancer Care Ontario
  • G. Porter Dalhousie University; Nova Scotia Health Authority
  • D. Turner CancerCare Manitoba; University of Manitoba
  • R. Urquhart Dalhousie University; Nova Scotia Health Authority;
  • M. Winget Stanford University School of Medicine
  • E. Grunfeld University of Toronto
  • for the Canadian Team to Improve Community-Based Cancer Care Along the Continuum
Keywords: Breast cancer, survivors, follow-up care, primary care

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.


Author Biographies

C. Kendell, Dalhousie University; Nova Scotia Health Authority
Cancer Outcomes Research Program
K.M. Decker, University of Manitoba; Cancer- Care Manitoba
Department of Community Health Sciences;
P.A. Groome, Queen’s University
Division of Cancer Care and Epidemiology, Cancer Research Institute
M.L. McBride, BC Cancer Agency
Cancer Control Research
L. Jiang, Queen’s University
Division of Cancer Care and Epidemiology, Cancer Research Institute
G. Porter, Dalhousie University; Nova Scotia Health Authority
Cancer Outcomes Research Program; Department of Surgery
D. Turner, CancerCare Manitoba; University of Manitoba
Epidemiology and Cancer Registry
R. Urquhart, Dalhousie University; Nova Scotia Health Authority;
Cancer Outcomes Research Program; Department of Surgery
E. Grunfeld, University of Toronto
Department of Family and Community Medicine
Published
2017-04-27
How to Cite
Kendell, C., Decker, K., Groome, P., McBride, M., Jiang, L., Krzyzanowska, M., Porter, G., Turner, D., Urquhart, R., Winget, M., Grunfeld, E., & Community-Based Cancer Care Along the Continuum, for the C. T. to I. (2017). Use of physician services during the survivorship phase: a multi-province study of women diagnosed with breast cancer. Current Oncology, 24(2), 81-89. https://doi.org/10.3747/co.24.3454
Section
Cancer Rehabilitation and Survivorship