Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

Abstract

BackgroundPrimary care providers (PCPs) have always played an important role in cancer diagnosis. There is increasing awareness of the importance of their role during treatment and survivorship. We examined changes in PCP utilization from pre-diagnosis to survival for women diagnosed with breast cancer, factors associated with being a high user of primary care, and variation across four Canadian provinces.MethodsThe cohorts included women 18+ years of age diagnosed with stage I-III invasive breast cancer in years 2007–2012 in British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS) who had surgery plus adjuvant chemotherapy and were alive 30+ months after diagnosis (N = 19,589). We compared the rate of PCP visits in each province across phases of care (pre-diagnosis, diagnosis, treatment, and survival years 1 to 4).ResultsPCP use was greatest during treatment and decreased with each successive survival year in all provinces. The unadjusted difference in PCP use between treatment and pre-diagnosis was most pronounced in BC where PCP use was six times higher during treatment than pre-diagnosis. Factors associated with being a high user of primary care during treatment included comorbidity and being a high user of care pre-diagnosis in all provinces. These factors were also associated with being a higher user of care during diagnosis and survival.ConclusionsContrary to the traditional view that PCPs focus primarily on cancer prevention and early detection, we found that PCPs are involved in the care of women diagnosed with breast cancer across all phases of care.

The effect of comorbidity on primary care use during breast cancer chemotherapy: a population-based retrospective cohort study using CanIMPACT data

“…Our study evaluated the effect of physical comorbidity and MHH on the change in PCP visit rates during breast cancer treatment. Similar to previous studies, [7][8][9] in this population-based cohort of women in Ontario with breast cancer, we found that the absolute number of PCP visits over 6 months increased from 2.3 at baseline to 3.4 during adjuvant chemotherapy. In our adjusted analyses, we found that although women with high physical comorbidity levels and MHH had more visits during the baseline and treatment periods, the increase in PCP visits from baseline to treatment periods was smaller than in those with low physical comorbidity levels and no MHH.…”

“…6 Despite the lack of a clear role for PCPs during breast cancer treatment, patients with breast cancer have been shown to visit their PCPs more often when they are receiving adjuvant chemotherapy than before their breast cancer diagnosis. [7][8][9] The reasons for this remain unclear. Previous qualitative work with providers suggests that PCPs' main roles in caring for patients with cancer are not to manage urgent issues during chemotherapy, but rather to coordinate care, manage comorbidities and provide psychosocial care.…”

Patient and Healthcare Provider Perspectives on the Implementation of a Web-Based Clinical Communication System for Cancer: A Qualitative Study

“…During interviews with patients, participants shared that their PCPs were involved in providing care primarily while they were undergoing diagnostic investigations and then after they completed treatment and were transferred from the cancer centre. However, results from administrative health data studies in four Canadian provinces show that patients with breast cancer were seen more often by PCPs during the treatment phase than pre-diagnosis, and were more likely to be high users of primary care with a greater number of comorbidities [ 17 ]. Perhaps the participants in this study were less complex patients with fewer comorbid conditions and as such, did not require extensive PCP involvement.…”

“…The overall goal of this program of research was to examine and address gaps in care coordination between oncology and primary care. After conducting several studies to identify gaps in cancer care coordination [ 3 , 7 , 14 , 15 , 16 , 17 ], the team organized a consultative workshop with stakeholders (patients, caregivers, PCPs, cancer specialists and health system administrators) to obtain recommendations for developing an intervention. Stakeholders recommended implementing a web-based communication system for asynchronous direct communication between PCPs and cancer specialists [ 18 ].…”

La Activación Conductual (AC) en mujeres con cáncer de mama durante la quimioterapia: análisis de la evolución de casos

“…Estudios sobre la calidad de vida del enfermo oncológico indican como la pérdida de funcionalidad y los cambios en las actividades diarias se relacionan con la aparición de alteraciones emocionales, mayor sintomatología y deterioro en la calidad de vida (1)(2)(3)(4)(5)(6) . Los problemas que ha de afrontar el paciente oncológico se asocian con las dificultades derivadas de la enfermedad y el tratamiento (síntomas, efectos secundarios, etc.).…”