Preventive Health Service Use Among Ovarian Cancer Survivors 公开
Loomer, Lacey Claire (2016)
Abstract
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
CHAPTER I: INTRODUCTION 1
Table 1. Society for Gynecologic Oncology's Self Care Plan 6
CHAPTER II: LITERATURE REVIEW 8
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
CHAPTER III: METHODOLOGY 16
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
CHAPTER V: DISCUSSION 51
Key Findings 51
Policy Implications 52
Limitations 53
Recommendations for Future Studies 54
CHAPTER VI: CONCLUSION 55
References 57
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