Identifying and characterizing cancer survivors in the US primary care safety net

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.

Keywords: electronic health records; neoplasms; primary health care; survivorship.

Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to declare.

© 2019 American Cancer Society.

Figures

Figure 1.. Adjusted odds ratios for select utilization indicators, CHC cancer survivors vs matched patients with no cancer history

Legend: Cancer survivors include those with any malignant cancer diagnosis excluding non-melanoma skin cancer. Cancer survivors were matched in 1:3 ratio with cancer-free patients on sex, year of birth, and primary health center. Odds ratios obtained from covariate-adjusted GEE models with standard errors clustered on match set ID to account for within-matched set correlation. All models controlled for race/ethnicity, adapted Charlson Comorbidity Index, insurance type, any uninsured visit in the study period, and years established with the primary health system; PCP model additionally adjusted for office visit count; visit utilization model additionally adjusted for PCP assignment; any opioid and chronic opioid models additionally adjusted for office visit count and PCP assignment. PCP model: p=0.03; all other models: p<0.001.