Identifying and Characterizing Cancer Survivors in the US Primary Care Safety Net

Authors

Megan Hoopes, OCHIN IncFollow
Teresa Schmidt, OCHIN IncFollow
Nathalie Huguet, Portland State UniversityFollow
Kerri Winters-Stone, Oregon Health and Science UniversityFollow
Heather Angier, Oregon Health and Science UniversityFollow
Miguel Marino, OHSU-PSU School of Public Health
Jackilen Shannon, OHSU-PSU School of Public Health
Jennifer DeVoe, Oregon Health and Science UniversityFollow

Sponsor

National Cancer Institute. Grant Number: 1R01CA204267-01, Patient‐Centered Outcomes Research Institute, People‐Centered Research Foundation. Grant Number: 1237

Published In

Cancer

Document Type

Citation

Publication Date

10-2019

Abstract

Background

Primary care providers must understand the use patterns, clinical complexity, and primary care needs of cancer survivors to provide quality health care services. However, to the authors' knowledge, little is known regarding the prevalence and health care needs of this growing population, particularly in safety net settings.

Methods

The authors identified adults with a history of cancer documented in primary care electronic health records within a network of community health centers (CHCs) in 19 states. The authors estimated cancer history prevalence among >1.2 million patients and compared sex‐specific site distributions with national estimates. Each survivor was matched to 3 patients without cancer from the same set of clinics. The demographic characteristics, primary care use, and comorbidity burden then were compared between the 2 groups, assessing differences with absolute standardized mean differences (ASMDs). ASMD values >0.1 denote meaningful differences between groups. Generalized estimating equations yielded adjusted odds ratios (aORs) for select indicators.

Results

A total of 40,266 cancer survivors were identified (prevalence of 3.0% of adult CHC patients). Compared with matched cancer‐free patients, a higher percentage of survivors had ≥6 primary care visits across 3 years (62% vs 48%) and were insured (83% vs 74%) (ASMD, >0.1 for both). Cancer survivors had excess medical complexity, including a higher prevalence of depression, asthma/chronic obstructive pulmonary disease, and liver disease (ASMD, >0.1 for all). Survivors had higher odds of any opioid prescription (aOR, 1.23; 95% CI, 1.19‐1.27) and chronic opioid therapy (aOR, 1.27; 95% CI, 1.23‐1.32) compared with matched controls (P < .001 for all).

Conclusions

Identifying cancer survivors and understanding their patterns of utilization and physical and mental comorbidities present an opportunity to tailor primary health care services to this population.

Description

© 2019 American Cancer Society

Locate the Document

http://doi.org/ 10.1002/cncr.32295

DOI

10.1002/cncr.32295

Persistent Identifier

https://archives.pdx.edu/ds/psu/30410

Citation Details

Hoopes, M., Schmidt, T., Huguet, N., Winters-Stone, K., Angier, H., Marino, M., … DeVoe, J. (2019). Identifying and characterizing cancer survivors in the US primary care safety net. Cancer, 125(19), 3448–3456.