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Many cancer survivors may not be getting optimal care for their other medical conditions, researchers from Boston's Dana-Farber Cancer Institute report in the journal Cancer (2004;101:1,712–1,719).

In a comparison of elderly colorectal cancer survivors and healthy control subjects, the cancer survivors were significantly less likely to receive preventive care and recommended care for chronic conditions, Craig Earle, MD, MSc, and Bridget Neville, MPH, found.

The results were not entirely surprising, said lead author Earle, a medical oncologist.

“A lot of [my] patients have said things that made me realize they think I'm looking after their other problems as well, when I'm not,” he said. “It made me wonder if their other [conditions] fall by the wayside because cancer takes over their lives for a few years.”

Earle and Neville compared the Medicare claims records of 14,884 colorectal cancer survivors and 16,659 control subjects, looking for noncancer-related services provided during 1997 and 1998. The cancer survivors, culled from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry, had all been diagnosed with nonmetastatic disease in 1991 or 1992 and had not been diagnosed with any subsequent malignancy nor been treated with chemotherapy or radiation during the study years. The exclusions were designed to limit the study population to a group of survivors still in relatively good health, for whom comorbidities and preventive care should not be ignored, Earle said. Control subjects were randomly chosen from a sample of Medicare patients with no cancer history and matched by age, race, gender, and geographic location.

Although the differences between the two groups were not enormous, compared with the healthy control subjects, the cancer survivors were significantly less likely to receive recommended monitoring of chronic heart and lung conditions. Just 64.3% of cancer survivors were given a lipid profile within 1 year of being diagnosed with angina, while 69.1% of healthy control subjects had the test in that time period (P = 0.01). And 87.5% of former cancer patients saw their provider every 6 months for follow-up of congestive heart failure compared with 94.1% of healthy control subjects (P < 0.001). Among patients with chronic obstructive pulmonary disease, 90.6% of cancer survivors saw a provider every 6 months as recommended compared with 93.3% of control subjects (P < 0.001).

Preventive care, too, fell short for the cancer survivors. Fewer of them received influenza vaccinations (53.2% versus 55.4% of control subjects; P < 0.001), cholesterol screening (36.5% versus 39.4%; P < 0.001), and eye examinations (47.4% versus 50.6%; P < 0.001).

The type of doctor visited seemed to make a difference in the level of care provided. Patients who visited only an oncologist fared worst in terms of overall care (management of comorbid conditions, preventive care, and acute care). Those who saw only a primary care doctor fared somewhat better, while patients who saw both types of providers had the best overall care. In terms of cancer screening, however, oncologists performed better than primary care physicians.

Earle attributes the gaps in care to poor communication both between doctor and patient and between different physicians.

In some cases, he said, cancer survivors lose touch with their primary care doctor and other specialists they may have had before their cancer diagnosis, because other conditions do seem less important by comparison. And some patients may not draw distinctions between physicians, not realizing that an oncologist may not offer the same services as a primary care provider.

“I think it's important for [cancer survivors] to keep in touch with their primary care doctor,” said Earle. “Ask if the doctor is comfortable doing cancer screenings, and if not, they should keep in touch with their oncologist.”

Physicians, too, should do more to be sure patients are getting the full spectrum of care they need, Earle said.

“The main thing for us oncologists is to make sure patients have a primary care doctor looking into other issues,” he said, noting that in a large survey by the American Society of Clinical Oncology, an overwhelming majority of oncologists indicated they did not want to provide primary as well as cancer care (Journal of Clinical Oncology 1996;14:2,612–2,621). Conversely, primary care doctors should know whether the cancer survivors they care for also expect them to do cancer-related follow ups. 

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Figure  . Cancer survivors may not be getting optimal care for comorbidities.

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