Role of the general practitioner during the active breast cancer treatment phase: an analysis of health care use

Abstract

PurposeLittle is known about the actual involvement of the general practitioner (GP) during the active breast cancer treatment phase. Therefore, this study explored (disease-specific) primary health care use among women undergoing active treatment for breast cancer compared with women without breast cancer.MethodsA total of 185 women with a first diagnosis of early-stage breast cancer between 1998 and 2007 were identified in the primary care database of the Registration Network Groningen and matched with a reference population of 548 women without breast cancer on birth year and GP.ResultsSince diagnosis, patients with breast cancer had twice as many face-to-face contacts compared with women from the reference population (median 6.0 vs 3.0/year, Mann–Whitney (M-W) test p < 0.001). The median number of drug prescriptions and referrals was also significantly higher among patients than among the reference population (11.0 vs 7.0/year, M-W test p < 0.001 and 1.0 vs 0.0/year, M-W test p < 0.001). More patients than women from the reference population had face-to-face contacts or were prescribed drugs for reasons related to breast cancer and its treatment, including gastrointestinal problems, psychological reasons and endocrine therapy.ConclusionsDuring the active breast cancer treatment phase, GPs are involved in the management of treatment-related side effects and psychological symptoms, as well as in the administration of endocrine therapy. Based on the findings of this study, interventions across the primary/secondary interface can be planned to improve quality of life and other outcomes in patients undergoing breast cancer treatment.

Increased primary health care use in the first year after colorectal cancer diagnosis

“…Moreover, healthcare use of CRC patients in primary care during treatment has not yet been studied. In a Dutch study on patients with breast cancer, increased contact rates with the GP were observed in the first year after diagnosis when compared with a reference population [12]. Similar findings were reported in a study conducted in Denmark concerning all cancer types [13], but the reasons associated with health care use were not examined in this study.…”

Increased primary healthcare utilisation among women with a history of breast cancer

“…A major strength of the present study is the use of a primary care database to analyse healthcare utilisation rates among women with a history of breast cancer and women without breast cancer from the same population [20]. As the presentation of health problems was recorded by GPs, our study is much less prone to recall or non-response bias than surveys with self-reported data on healthcare use [36].…”

“…Face-to-face contacts included consultations in general practice and home visits carried out by GPs and other general practice workers [20]. Observation time was calculated as time since matching date until the endpoints (e.g., breast cancer recurrence, death, and departure) ( Table 1).…”

“…The process of identification of patients in this database and the collection of additional information in participating general practices has recently been published [20]. Confirmation of breast cancer in history was obtained for 400 patients.…”

“…Furthermore, patients and women from the reference group were observed for the first 5 years of the follow-up period, when enlisted with their GP in these years. As in our previous analysis [20], data collected by the RNG between 1998 and 2007 were entered into an anonymous database. Extracted were: patient contacts recorded by participating GPs using the International Classification of Primary Care (ICPC) version 1 [21], prescribed medication automatically classified according to the Anatomical Therapeutical Chemical (ATC) classification, and referrals by specialty [22].…”