Background: Cancer diagnosis has the potential to overshadow patients’ general medical care needs. This study examined changes in general medical care among elderly patients with col'/>
Receipt of General Medical Care by Colorectal Cancer Patients: A Longitudinal Study
id="p1">Background: Cancer diagnosis has the potential to overshadow patients’ general medical care needs. This study examined changes in general medical care among elderly patients with colorectal cancer (CRC), from before diagnosis through long-term survival. id="p-2">Methods: This longitudinal cohort study used 1993 to 1999 Surveillance, Epidemiology, and End Results and 1991 to 2001 Medicare claims data for 22,161 patients with stage 0 to 3 CRC and 81,669 controls aged 67 to 89 years. Outcomes were preventive services (influenza vaccination, mammography) and, among diabetics, HgbA1c and lipid testing in the phase before diagnosis, the phase after initial treatment, the surveillance phase, and the survival care phase. Logistic regression provided adjusted relative risks of care receipt for patients with stage 0 to 1 cancer, stage 2 to 3 cancer, and no cancer. id="p-3">Results: In the phase before diagnosis through the surveillance phase, patients with stage 0 to 1 CRC had the highest annual preventive service rates. Patients with stage 2 to 3 CRC made substantial gains in preventive service use, especially mammography, after diagnosis (influenza vaccination, 46.4% before diagnosis to 50.2% after initial treatment; mammography, 31.4% before diagnosis to 40.2% after initial treatment) but not in diabetes care (eg, HgbA1c, 53.4% before diagnosis to 54.9% after initial treatment). id="p-4">Conclusions: CRC diagnosis seems to facilitate receipt of preventive services but not diabetes care for elderly, later-stage patients. Additional strategies such as strengthening partnerships between cancer patients, primary care physicians, and cancer care physicians are needed to improve care for a chronic disease like diabetes. class="kwd-group KWD">
>class="kwd-search" href="/search?fulltext=Quality+of+Care&sortspec=date&submit=Submit&andorexactfulltext=phrase">Quality of Care
>class="kwd-search" href="/search?fulltext=Survivorship&sortspec=date&submit=Submit&andorexactfulltext=phrase">Survivorship id="p-5">Approximately 70% of all cancer patients are aged ≥65 years and enter the cancer care system with a broad range of medical conditions and preventive care needs.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1–4 However, cancer diagnosis has the potential to overshadow these general medical care needs. Several studies suggest that addressing cancer patients’ general medical care can have an important impact on survival.id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5–10 Higher mortality among black patients who are receiving cancer treatment comparable to that being received by white patients is largely related to deaths from other conditions.id="xref-ref-5-2" class="xref-bibr" href="#ref-5">5 Influenza vaccination receipt by patients with advanced-stage colorectal cancer (CRC) has been associated with increased survival.id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 Beyond survival, Ramsey et alid="xref-ref-11-1" class="xref-bibr" href="#ref-11">11 have demonstrated that noncancer comorbidity is the strongest predictor of quality of life for most CRC survivors. id="p-6">Relatively little research has been published about general medical care among cancer patients. Earle and Nevilleid="xref-ref-12-1" class="xref-bibr" href="#ref-12">12 found that 5-year CRC survivors received less preventive and chronic disease care than noncancer patients matched on demographics and geography. Lower influenza vaccination rates have been found among elderly patients with advanced-stage CRC in chemotherapy compared with their elderly noncancer counterparts.id="xref-ref-6-2" class="xref-bibr" href="#ref-6">6 Conversely, Snyder et alid="xref-ref-13-1" class="xref-bibr" href="#ref-13">13 found increases in influenza vaccination but decreases in mammography and cervical cancer screening in the 5 years after initial treatment among patients with stage 1 to 3 CRC. However, none of these studies examined whether there was a change in these patients’ receipt of general medical care services before and after cancer diagnosis, nor did they compare cancer patients’ general medical care se
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机译：id =“ p1”> 背景：癌症诊断有可能使患者的一般医疗需求蒙上阴影。这项研究调查了从诊断前到长期生存的老年大肠癌（CRC）患者的一般医疗护理变化。 id =“ p-2”> 方法：这项纵向队列研究使用了1993年至1999年的监测，流行病学和最终结果以及1991年至2001年的Medicare索赔数据，涉及22,161例分期患者0至3名CRC和81,669名对照，年龄67至89岁。结果是预防服务（流行性感冒疫苗接种，乳房X线摄影），以及在糖尿病患者中，诊断前，初始治疗后，监测阶段和生存护理阶段的HgbA1c和血脂测试。 Logistic回归为患有0至1期癌症，2至3期癌症且无癌症的患者提供了调整后的相对护理风险。 id =“ p-3”> 结果：在诊断之前的整个阶段（通过监视阶段），CRC为0到1期的患者的年度预防服务率最高。患有2至3期CRC的患者在诊断后在预防服务，尤其是乳腺X线摄影方面取得了重大进展（流感疫苗接种，诊断前为46.4％，初始治疗后为50.2％;乳腺X线摄影，诊断前为31.4％，初始治疗后为40.2％），但没有在糖尿病治疗中（例如HgbA1c，在诊断前为53.4％，在初始治疗后为54.9％）。 id =“ p-4”> 结论： CRC诊断似乎有助于接受预防服务，但对老年晚期患者的糖尿病护理不利。需要其他策略，例如加强癌症患者，初级保健医生和癌症保健医生之间的伙伴关系，以改善对糖尿病等慢性疾病的保健。 class =“ kwd-group KWD”>
