Preventive Health Service Use Among Ovarian Cancer Survivors Open Access

Loomer, Lacey Claire (2016)

Permanent URL:


Previous studies have examined preventive health service utilization differences between cancer survivors and non-cancer controls and have found mixed results. No previous research has examined preventive health services among ovarian cancer survivors, who have different survival outcomes and experiences than cancer survivors examined in past studies. This study examined elderly ovarian cancer survivors' adherence to evidence-based guidelines regarding post-treatment receipt of flu vaccinations, screening mammography and bone density tests. The study included women with ovarian cancer diagnosed from 2001-2010, who were age 66 or older. Ovarian cancer survivors were matched to non-cancer controls on age, race and state from a 5% random Medicare Beneficiary file. Logistic regression models were used to compare the likelihood of receipt of preventive health services for cancer survivors compared to controls. Results showed that cancer survivors were more likely to be adherent to flu vaccine and mammography, but no differences were found for bone density test adherence. Racial and socio-economic disparities were identified: blacks were less likely to be adherent to all three preventive health services when compared to white counterparts, and those with state Medicaid Buy-in were less likely to be adherent compared to those without state Medicaid Buy-in. Adherence to guidelines by cancer survivors was not substantially influenced by their rate of receipt of cancer surveillance visits or by their intensity of interaction with the health care system, as indexed by the overall physician visit rate. Similarly, among controls the magnitude of health system interaction on adherence was small. After controlling for all measureable factors, substantial differences remained between survivors and controls for two of the three measures. Therefore, differences in adherence are likely attributable to differences between the groups on unmeasured variables. An important avenue to explore these differences is patient-reported on factors influencing attitudes towards using preventive services, along with barriers and facilitators to toward use of healthcare. This could be helpful in enhancing understanding of ovarian cancer survivors' attitudes toward cancer and non-cancer care following initial cancer therapy. Survivorship Care Plans, as advocated by major cancer organizations, should emphasize preventive health services, in addition to surveillance for cancer recurrence.

Table of Contents


Table 1. Society for Gynecologic Oncology's Self Care Plan 6


Ovarian Cancer 8

Ovarian Cancer Survivors 10

The importance of preventive health services 12

Preventive health services for cancer survivors 12

Preventive Health Services for Ovarian Cancer Survivors 15


Study Aims and Research Questions 16

Institutional Review Board 17

Data Source 17

Background 18

Study Sample Identification 18

Figure 1. Each of the models for PHS will have a 2-year time frame 19

Figure 2. Flow Chart for Analytic Sample 22

Figure 3. Flow Chart for cases and matching controls 23

Conceptual Framework 24

Figure 4. Conceptual Framework 25

Figure 5. Focal Relationship 26

Focal Relationship 27

Confounders and their association with constructs in the focal relationship 28

Predisposing characteristics 28

Enabling characteristics 29

Need characteristics 29

Measures 30

Dependent Variable 30

Focal Independent Variable 30

Predisposing characteristics. 30

Table 2. Measurement of Adherence to PHS Recommendations 30

Enabling characteristics 31

Need characteristics 31

Table 4. Exogenous variables measurement and hypotheses 32

Analytic Strategy 33

Table 5: Variables being used in models 34

Aim 1. Pooled Models 35

Pooled Model using common covariates 36

Aim 2. Individual Models 36

Cancer model using best available covariates 36

Non-cancer model using the best available covariates 37

CHAPTER IV: Results 37

Descriptive Statistics 37

Table 6. Descriptive statistics: Analytic Sample 38

Table 7. Comparison between cancer survivors (cases) and non-cancer controls (controls) unadjusted adherence rates to flu vaccine guidelines 40

Table 8. Comparison between cancer survivors (cases) and non-cancer controls (controls) unadjusted adherence rates to mammography guidelines 41

Table 9. Comparison between cancer survivors (cases) and non-cancer controls (controls) unadjusted adherence rates to bone density guidelines 42

Logistic Results 42

Table 10. Do ovarian cancer survivors have different adherence to flu vaccine guidelines when compared to non-cancer controls? 44

Table 11. Do ovarian cancer survivors have different adherence to mammography guidelines when compared to non-cancer controls? 46

Table 12. Do ovarian cancer survivors have different adherence to bone density guidelines when compared to non-cancer controls? 48

Pooled Results 50

Cancer Model Results 50

Non-cancer Model Results 51


Key Findings 51

Policy Implications 52

Limitations 53

Recommendations for Future Studies 54


References 57

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files