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Table 2 Study results

From: An international review of the patterns and determinants of health service utilisation by adult cancer survivors

Author

Outcome

Predisposing characteristics

Enabling characteristics

Need characteristics

Andersen and Urban [36]

Follow-up cancer surveillance

 

Previous diagnosis via this method. Physician recommendation.

70 % received mammography in first year. 72 % received mammography in two years.

Andrykowski and Burris [45]

Mental health service use

 

Rural are less likely to have mental health services within 30 mile radius.

18 % of non-rural and 8 % of rural CSs utilised psychologist services.

Boehmer et al. [34]

Follow-up cancer surveillance

Female CSs less likely than male CSs to receive either colonoscopy or sigmoidoscopy within 1 and 3 years of treatment. Black CSs more likely than white CSs to receive follow-up screening.

A greater number of outpatient visits.

 

Cooper et al. [29]

Follow-up cancer surveillance

Older CSs less likely than younger CSs to receive screening within 5 years of diagnosis.

Geographical variation in receipt.

CSs with a co-morbidity were less likely than CSs without a co-morbidity to receive colonoscopy or sigmoidoscopy in first year of survivorship. Increase in receipt of surveillance procedures over time. Over a 3 year period: 58 % of CSs received on average 2.8 colonoscopies; 19 % received on average 2.0 colonoscopies.

Cooper and Payes [28]

Follow-up cancer surveillance

Older CSs less likely than younger CSs to receive screening within 3 years of diagnosis. Female CSs were more likely than male CSs to receive screening within 3 years of diagnosis. White CSs were more likely than black CSs to receive screening.

Visits to a primary care physician.

Receipt of colonoscopy increased over time. No difference in receipt of FOBT or colonoscopy between CSs and controls.

Cooper, Kou and Reynolds [31]

Follow-up cancer surveillance

Older CSs less likely than younger CSs to receive follow-up which adheres to professional guidelines. White CSs more likely than Black CSs to receive follow-up which adheres to professional guidelines.

 

CSs with a comorbidity were more likely than CSs without a co-morbidity to receive CEA testing. CSs with later stage and undifferentiated tumour were more likely to exceed guidelines. Decrease over time in receipt of barium enema and sigmoidoscopy.

Doubeni et al. [27]

Primary care use Follow-up cancer surveillance

Younger CSs were more likely to receive a mammography compared to older CSs. White CSs were more likely to receive a mammography compared to black CSs.

 

Visits to a family physician increased from 55-71 % over a 5 year period. CSs with co-morbidities were less likely than CSs without co-morbidities to receive a mammography.

Earle et al. [23]

Primary care use Preventative care

Older CSs were less likely to receive preventative care compared to younger CSs. Black CSs were less likely to receive preventative care compared to white CSs CSs with lower SES were less likely to receive preventative care compared to CSs with higher SES. CSs residing in a rural area were less likely to receive preventative care compared to CSs residing in an urban area.

Visits to a primary care physician and an oncology specialist.

52 % of CSs followed up by both an oncology specialist and primary care physician. 41 % of CSs followed up by primary care physician only. 4 % of CSs followed up by oncology specialist only. CSs with a co-morbidity were more likely to receive preventative care compared to CSs without a co-morbidity. CSs received more preventative care compared to controls.

Earle and Neville [19]

Primary care use Preventative care

Non-white CSs were less likely than white CSs to receive preventative care. Older CSs compared to younger CSs were less likely to receive preventative care.

No visits to primary care physician or oncology specialist led to less preventative care receipt.

CSs compared to general population were more likely to visit a primary care physician. 50 % of CSs visited oncology specialist and other physicians. 8 % of CSs visited oncology specialist only. CSs with a co-morbidity were less likely to receive lipid testing than CSs without a co-morbidity. CSs were less likely than controls to receive lipid or cholesterol testing.

Earle, Neville and Fletcher [43]

Mental health service use

Younger breast CSs (>65 years old) were most likely to use mental health services.

 

CSs compared to controls were more likely to report anxiety and sleep disorders and have greater use of mental health services. 18 % of CSs made at least 2 or 3 visits to a psychologist. Breast cancer survivors had greatest level of use.

Ellison et al. [33]

Follow-up cancer surveillance

White CSs were more likely to receive post-treatment surveillance compared to black cancer survivors.

 

Use of colorectal surveillance test increased over time for colorectal CSs.

Gray et al. [41]

Mental health service use

Younger CSs were more likely to use mental health services than older CSs. CSs who were employed were more likely to receive mental health services than CSs who were unemployed. CSs who were students were more likely to receive mental health services than CSs who were not students.

CSs who had additional health insurance were more likely to use mental health services than CSs who did not have additional insurance.

 

Gray et al. [42]

Mental health service use

Younger CSs were more likely to use mental health services compared to older survivors.

CSs with additional health insurance, higher income and higher education were more likely to use mental health services compared to CSs without additional health insurance, with lower income and education.

Younger CSs, with additional health insurance and a higher level of education expressed a need for services that they were not receiving. 31 % CSs made at least one visit to a mental health professional, 5 % to a psychologist and 4 % were to a psychiatrist. 0-11 % of CSs used social services, dieticians, physiotherapists and other health care providers.

Grunfeld et al. [16]

Hospital care

  

CSs led by hospital follow-up had lower health service use compared to CSs led by primary care physician follow-up.

Grunfeld et al. [17]

Primary care use

 

A small proportion of CSs followed up by primary care physician made contact with an oncologist in a 12 month period.

 

Keating et al. [25]

Primary care use Follow-up cancer surveillance

Younger and white CSs were more likely to receive a mammogram than CSs who were older and black.

Visits to oncology specialists led to a greater likelihood in the receipt of mammogram by CSs.

Visits to primary care physicians increased over time, whereas visits to oncology specialists decreased over time. A recent diagnosis, a second cancer, large tumour and no radiotherapy receipt led to a greater likelihood of mammography receipt.

Keating et al. [11]

Primary care use

Younger CSs were more likely to visit an oncology specialist.

 

The role of care provided by both primary care physicians and oncology specialists decreased over a three year period. Annual follow-up was provided to 51 % of breast CSs by primary care physicians and 27 % of CSs by oncology specialists.

Khan et al. [38]

Follow-up cancer surveillance Preventative care

Older CSs were more likely than younger survivors to receive influenza vaccination.

A greater number of visits to a health care provider facilitated receipt of preventative care.

Receipt of mammography decreased over time. CSs compared to the general population had similar rates of cholesterol testing and blood pressure monitoring. Colorectal CSs were more likely to receive PSA testing. Breast CSs were less likely than the general population to receive preventative care with the exception of bone densitometry.

Khan, Watson and Rose [20]

Primary care use

  

Visits to primary care physician increased over time by CSs. CSs compared to the general population were more likely to visit their primary care physician.

Knopf et al. [37]

Follow-up cancer surveillance

  

Receipt of a number of colorectal cancer surveillance procedures increased over time for colorectal CSs following treatment.

Lafata et al. [30]

Follow-up cancer surveillance

Older CSs were less likely than younger CSs to receive follow-up screening within 5 years of treatment with curative intent. White CSs were more likely to receive follow-up screening than black CSs.

 

Receipt of colonoscopy and CEA and metastatic disease testing increased over time.

Mahboubi et al. [15]

Primary care use Follow-up cancer surveillance

CSs living in specific geographic areas.

21 % of all colorectal surveillance procedures within 3 years of curative surgery were delivered by a primary care physician and 41 % by a gastroenterologist or oncology specialist.

Increased visits to primary care physicians over time.

Mandelblatt et al. [13]

Primary care use Hospital care Follow-up cancer surveillance

White CSs were more likely to utilise health services than black CSs.

 

CSs with a co-morbidity, self-reported poor functioning and high depression scores had greater use and cost of health services. Within the first year of survivorship an average of 14 visits per CS was made to a medical provider. An average of 3 visits to a physiotherapist/occupational therapist per CS was made. 62 % of CSs received a mammography.

Mayer et al. [35]

Follow-up cancer surveillance

CSs had a greater absolute or comparative risk of developing cancer compared to the general population.

Physician recommendation increased likelihood of screening.

Greater receipt of screening among CSs compared to general population.

McBean, Yu and Virnig [39]

Preventative care

Older and black CSs were less likely to receive preventative care compared to younger and white CSs.

Uterine CSs most likely to receive mammography if seen by a gynaecologist or an oncology specialist. CSs most likely to receive bone densitometry and influenza vaccination if seen by a primary care physician. Receipt of each test most likely if at least 5 visits to a physician and no overnight hospital stays.

Uterine CSs more likely to receive colorectal or breast cancer screening than the general population.

Mols, Helfenrath and van de Poll-Fanse [14]

Primary care use Hospital care

  

CSs had similar use of primary care physician compared to general population. 0-11 % utilised social services, dieticians and physiotherapists.

Mols, Coebergh and van de Poll-Fanse [22]

Primary care use Mental health service use

CSs diagnosed between 10 and 15 years previously, who were single or divorced were less likely to utilise health services compared to CSs diagnosed at different time-points and CSs with partners.

Higher education enabled use of mental health services.

CSs with a co-morbidity were twice as likely to utilise primary care physician services than CSs without a co-morbidity. Endometrial CSs had greater use of health services than the general population. 1-10 % of CSs utilised psychologist services.

Oleske et al. [47]

Hospital care

  

25 % of CSs had at least one overnight hospital stay. Experiencing menopausal symptoms and high CES-D scores led to more inpatient stays.

Peuckmann et al. [12]

Primary care use

Older CSs (<75 years old) were most likely to visit their primary care physician within 3 years of treatment.

 

CSs had similar primary care physician use compared to the general population. Breast CSs had greater use of allied health professionals than the general population.

Schapira, McAuliffe and Nattinger [32]

Follow-up cancer surveillance

  

CSs with a co-morbidity were less likely than CSs without a co-morbidity to receive a mammography. 23 % of CSs received a macmography in the first 2 years following treatment.

Schootman et al. [44]

Hospital care

Older, divorced or widowed CSs were more likely to be an inpatient than CSs who were younger, not divorced and not widowed. CSs who were not black or white were less likely to be an inpatient than CSs who were black or white.

CSs living in an impoverished area were more likely to have an overnight stay in hospital compared to CSs living in more affluent areas. CSs who had visited their physician at least once were less likely to have an overnight stay than CSs who did not visit their physician.

13 % of CSs had at least one overnight hospital stay. CSs with at least one co-morbidity were more likely to have an overnight stay compared to CSs without a co-morbidity.

Simpson, Carlson and Trew [18]

Primary care

 

Participation in psychotherapy intervention led to a reduction in health service use by CSs.

 

Snyder et al. [9]

Primary care use Preventative care

Younger, female colorectal CSs were more likely to receive care form both a primary care physician and oncology specialist compared to older, male CSs. Older CSs less likely to receive cholesterol testing, cervical examination and bone densitometry than younger CSs.

CSs who lived in an urban area compared to CSs who lived in a rural area were more likely to receive mammography, cervical smear and influenza vaccination. Most likely to receive preventative care if followed-up by both primary care physician and oncology specialist. CSs living in rural areas were less likely to receive mammography compared to CSs living in urban areas.

CSs had increased visits over time to primary care physician. CSs had decreased visits to oncology specialists over time. Receipt of mammography and cervical screening decreased over time. Bone densitometry remained low. Rates of influenza vaccination fluctuated over time. CSs with a co-morbidity were less likely to receive cervical screening and bone densitometry, but greater receipt of influenza vaccination, cholesterol testing than CSs without a co-morbidity.

Snyder et al. [10]

Primary care use Preventative care

Older CSs (>85 years old) were more likely to receive care from a primary care physician compared to CSs aged <75 years old. Black CSs were more likely to receive care from physicians other than a primary care physician. Black CSs compared to white CSs were less likely to receive care from a primary care physician. Non-white CSs were less likely to receive influenza vaccination than white CSs. Older CSs less likely to receive cholesterol testing and bone densitometry but were more likely to receive influenza vaccination than younger CSs.

Most likely to receive preventative care if followed-up by both primary care physician and oncology specialist.

CSs had increased visits over time to other physicians. CSs with a co-morbidity were less likely to receive cervical screening and bone densitometry, but greater receipt of influenza vaccination, cholesterol testing and mammography than CSs without a co-morbidity.

Snyder et al. [24]

Primary care use Follow-up cancer surveillance Preventative care

 

Breast CSs were most likely to receive preventative care if visits were made to an oncology specialist and a primary care physician.

Majority of CSs followed up by both oncology specialist and primary care physician over time. Increased visits to oncology specialist over time. Decreased visits to primary care physician over time. Breast CSs had greater use of mammography compared to the general population. Breast CSs received less preventative care than the general population. CSs more likely to receive preventative care if general population has a co-morbidity.

Snyder et al. [26]

Primary care use Preventative care

  

Increased visits to primary care physician over time. Decreased visits to oncology specialist over time. Breast CSs received less preventative care than the general population.

Van de Poll-Fanse et al. [21]

Primary care use

Younger CSs were more likely to visit an oncology specialist compared to older CSs.

 

Breast CSs had similar primary care physician use as the general population.

Yu, McBean and Virnig [40]

Follow-up cancer surveillance

Older CSs were less likely to receive mammography compared to younger CSs.

CSs with state health insurance were less to receive a mammography compared to CSs with alternative health insurance. CSs living in a rural area were less likely to receive mammography compared to CSs living in an urban area. Care from a gynaecologist rather than a primary care physician led to greater receipt of mammography.

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