1088 — Long-Term Cancer Survivorship Care in the VA Greater Los Angeles Healthcare System
Hsiao WC, and Malin JL, VA Greater Los Angeles Healthcare System;
In the United States, there are currently over 12 million cancer survivors, underscoring an urgent need for research in cancer survivorship care. To gain a quantitative view of survivorship care management, we assessed the coordination of care and surveillance processes for cancer survivors in the VA Greater Los Angeles Healthcare System (VA GLAHS).
We abstracted the CPRS medical records of patients in VA GLAHS diagnosed with early stage cancers in 2004-2006 and followed their care up through the first four years of survivorship (Year 1 of survivorship = 366-731 days post-diagnosis) to determine the number of visits at each of the cancer specialists and primary care providers each year as well as receipt of cancer screening tests and imaging. Patients who died or who have a history of >1 primary cancer were excluded.
Veterans eligible for survivorship care in the year following diagnosis (n = 300) included patients with head/neck (8%), colorectal (16%), other gastrointestinal (14%), lung( 14%), breast/uterus (3%), prostate (40%), or lymphoma (5%) cancers. The mean age (SD) at diagnosis was 65 (10) years; 96% were male; 58% white and 27% black. Patients visited primary care providers (PCPs) the most frequently and consistently compared to medical oncology, radiation oncology, and surgery providers (Mean PCP visits [SD]: Year 1 = 1.73[2.08], Year 2 = 1.66[2.03], Year 3 = 1.71[2.12], Year 4 = 1.52[1.93]). However, PCPs only addressed cancer in their assessment and plan (A/P) in half of the visits (Mean PCP notes with cancer in A/P [SD]: Year 1 = 1.16[1.53], Year 2 = 1.12[1.60], Year 3 = 1.12[1.63], Year 4 = 1.04[1.50]). Although routine imaging is not recommended for most cancers, patients received ~1 CT or PET/CT scan per year. In contrast, patients with colorectal cancer did not consistently receive recommended colonoscopy, CEA, or CT scans of the abdomen. Prostate cancer patients received greater than the recommended number of PSA tests in Year 1 (Mean PSA tests received [SD] = 2.32[1.66]) but did not have adequate surveillance in subsequent years.
Although guidelines recommend that patients continue to follow-up with their oncologists after completing cancer therapy, few patients appeared to adhere to the recommended schedule of visits.
Primary care-based models of survivorship care may improve adherence to recommended surveillance.