Date of Award

January 2021

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Brenda Cartmel

Second Advisor

Leah Ferrucci

Abstract

Abstract

Introduction: The number of long-term (>5 years post-diagnosis) cancer survivors in the United States is growing, making it critical to understand how they utilize healthcare for their past cancer diagnosis. There are limited data on patient characteristics associated with care utilization patterns. Methods: Data are reported from the 9-year post-diagnosis follow-up of the Connecticut participants (n=399) in the American Cancer Society’s Study of Cancer Survivors-I. We assessed characteristics associated with long-term primary cancer care provider (cancer specialist vs. primary care physician (PCP), shared care vs. PCP) and number of PCP visits in the past year via multinomial logistic regression and ordinal logistic regression, respectively. Results: Over half (53.1%) of survivors reported a cancer specialist as their primary cancer care provider, followed by PCP (28.8%) and shared care between specialist and PCP (18.0%). Females with breast cancer were more likely to report cancer care provided by cancer specialist or shared care versus PCP than any other cancer type. Those with regional/distant cancer at diagnosis were more likely to report cancer specialist versus PCP than those with in situ/local cancer. Those with a college degree or some graduate/professional school were more likely to report cancer specialist vs. PCP than those with high school or less. Comorbid conditions were associated with increasing PCP visits in the past year as compared to no comorbid conditions. Conclusion: Utilization of cancer specialists for cancer follow-up was common in these long-term cancer survivors. Cancer type, stage at diagnosis, and education were associated with type of provider. Our findings highlight the need to address who follows long-term cancer survivors due to an anticipated shortage of oncologists in the United States. Further studies should explore if primary cancer care provider type is associated with type and quality of care.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2023

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