Comorbidities and Health Care Services Utilisation Among Long-term Breast Cancer Survivors (SURBCAN)

The increased likelihood of survival can be explained by numerous factors, such as improvements in breast cancer screening and advances in diagnosis and treatment and aging. This phenomenon is associated with comorbidity due to cancer treatment and external factors like aging or lifestyle. Little is known about how these women follow-up their disease, their pattern of use of health resources and their met and unmet needs. Studying the health needs of these women is a cancer-related priority for Cancer Organizations.The project is aimed at: 1) Describing the comorbidities and patterns of use of primary and specialized care in women who have survived a breast cancer for at least five years; 2) Comparing the comorbidities and patterns of use of long time breast cancer survivors with women without a cancer diagnosis; and 3) Estimating the use of resources in long time survivors of breast cancer adjusted for survival-time and comorbidities.

Study Overview

• Status: Completed
• Conditions: Breast Cancer

Detailed Description

The general objective of this study is to analyze the pattern of comorbidities and utilization of primary care officers and specialized attention of long-term breast cancer survivors and to compare it with women without history of cancer. Long-term breast cancer survivors are those women who survived for at least five years since de primary breast cancer diagnosis.The use of health care services for long-term breast cancer survivors presents new challenges for health systems in terms of defining the role of each health professional and each level of care in contact with these women during their follow-up.

The SURBCAN Project is an observational study that includes a retrospective cohort of women from five Spanish areas. The study is based on Real World Data from clinical history and tumor registration. Women with a diagnosis of breast cancer and a survival period of ≥ 5 years were identified, as well as those women without a cancer diagnosis and matched by age and area with breast cancer survivors (1:2). N= 21639 women (7241 cases /13,398 controls). Sociodemographic and clinical variables were included. The use of primary care and hospital attention and the presence of comorbidities were assessed during the follow-up period (2012-2016). The basal cohort, the comorbidities and the use of health services were described. Factors associated with use were analyzed through multi-level logistic regression models.

Expected results: Nowadays there are no results of cohort analysis that focus specifically in long-term breast cancer survivors. The SURBCAN study will provide evidence regarding comorbidity patterns and follow-up characteristics. The results will guide the elaboration of new recommendations and the decision making by stakeholders concerned to breast cancer survivor's follow-up.

This project combines the experience from experts groups in health services assessment, and analysis of comorbidities and chronic diseases, belonging to the REDISSEC network.

• Study Type: Observational
• Enrollment (Actual): 21639

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Women with a diagnosis of breast cancer (during 2000 until 2006) with a survival period of ≥ 5 years that had a visit with the healthcare services during the period from 2012 to 2016 were identified, as well as those women without a cancer diagnosis and matched by age and area with breast cancer survivors.

Description

Inclusion Criteria:

• >18 years old
• Women diagnosed with an incident breast cancer during the period from 01/01/2000 until 31/12/2006 who survived for at least 5 years.
• Women who visited at least once the primary health services during follow-up period (01/01/2012 to 31/12/2016).

Exclusion Criteria:

- Unknown diagnostic year

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Long-term breast cancer survivors; Analyze comorbidities and patterns of use of health services. Describe the specific use of health services in primary care vs. specialized care. Analyze comorbidities and patterns of use of health services by tumor characteristics.
Women without history of cancer; Analyze comorbidities and patterns of use of health services. Describe the specific use of health services in primary care vs. specialized care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of comorbidities	Number of comorbidities of each woman at five-year survival from breast cancer. Assessed through ICD10.	5 years of survival
Frequency of visits to healthcare services	Number of visits to primary care attention or specialised attention done by each women at five-year survival from breast cancer.	5 years of survival
Main health provider visited	Leading provider of health services (GP, oncologist, community nurse, oncology nurse, physiotherapist...) of each women at five-year survival from breast cancer.	5 years of survival

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of visits to primary care attention	Number of visits to primary care attention done by each women at five-year survival from breast cancer.	at 5 years of survival
Frequency of visits to specialized care attention	Number of visits to specialised attention done by each women at five-year survival from breast cancer.	at 5 years of survival
Annual mammogram frequency	Assessment of the percentage of women who have a mammogram every year.	1 year

Collaborators and Investigators

• Sponsor: Parc de Salut Mar
• Collaborators: Fondo de Investigacion Sanitaria; European Regional Development Fund; Red de Investigación en Servicios de Salud en Enfermedades Crónicas

Publications and helpful links

General Publications

• Jansana A, Del Cura I, Prados-Torres A, Sanz Cuesta T, Poblador-Plou B, Gimeno Miguel A, Lanzuela M, Ibanez B, Tamayo I, Moreno-Iribas C, Padilla-Ruiz M, Redondo M, Comas M, Domingo L, Diaz-Holgado A, Salamanca FJ, Castells X, Sala M; SURBCAN group. Use of real-world data to study health services utilisation and comorbidities in long-term breast cancer survivors (the SURBCAN study): study protocol for a longitudinal population-based cohort study. BMJ Open. 2020 Sep 9;10(9):e040253. doi: 10.1136/bmjopen-2020-040253.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2012
• Primary Completion (Actual): January 1, 2012
• Study Completion (Actual): December 31, 2016

Study Registration Dates

• First Submitted: February 13, 2019
• First Submitted That Met QC Criteria: February 19, 2019
• First Posted (Actual): February 20, 2019

Study Record Updates

• Last Update Posted (Actual): February 20, 2019
• Last Update Submitted That Met QC Criteria: February 19, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Keywords: breast cancer; survival; comorbidities; healthcare services research
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms
• Other Study ID Numbers: SURBCAN Project

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No