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Determinants of increased primary health care use in cancer survivors.

Heins, M., Schellevis, F., Rijken, M., Hoek, L. van der, Korevaar, J. Determinants of increased primary health care use in cancer survivors. Journal of Clinical Oncology: 2012, 30(33), p. 4155-4160.
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Purpose: The number of cancer survivors is increasing, and patients with cancer often experience long-lasting consequences of cancer and its treatment. Because of the variety of health problems and high prevalence of comorbidity, primary care physicians (PCPs) seem obvious candidates to take care of these patients, and insight into primary health care (PHC) use of cancer survivors is needed. We aimed to find determinants for PHC use in cancer survivors. Methods: Using data from the Netherlands Information Network of Primary Care, we determined the volume of PHC use in 1,256 adult patients with breast cancer, 503 patients with prostate cancer, and 487 patients with colorectal cancer 2 to 5 years after diagnosis and compared this with age- and sex-matched controls without cancer from the same practice. We also examined whether age, comorbidity, and time since diagnosis were related to PHC use. Results: The mean annual number of primary care contacts was increased compared with control patients by 24% in patients with breast cancer (P < .001) and by 33% in patients with prostate cancer (P < .001). This difference remained constant between 2 and 5 years after diagnosis. In patients with colon cancer, the difference with controls tended to decrease with age (12% per 10 years; P = .005). Conclusion: PHC use is significantly increased 2 to 5 years after diagnosis of cancer, especially in younger patients without a chronic disease. Given the expected increase in cancer survivors, PCPs should prepare themselves for this increasing amount of aftercare. The development of multidisciplinary care standards for cancer survivors could be helpful. (aut. ref.)