Preventive Health Care Use in Elderly Cancer Survivors

描述(由申请人提供) 许多癌症类型的5年相对生存率很高，这意味着癌症幸存者应该得到推荐的临床预防服务，以及其他并存慢性病的优质医疗保健。重要的是，包括各个种族和民族的老年人在内的美国老年人，无论他们是否从癌症中幸存下来，都能获得这些服务，这一点很重要，也符合2010年健康人的目标。这项研究将测试推荐的临床预防服务，包括癌症筛查以及糖尿病护理质量指南，是否在乳腺癌、子宫癌、结肠癌和直肠癌、膀胱癌或前列腺癌幸存者中得到满足，与未患癌症的老年人一样频繁。我们将研究的服务包括(A)流感疫苗接种；(B)美国糖尿病协会建议的糖尿病护理质量措施：测定血清血红蛋白(HbA1c)和低密度脂蛋白(LDL-C)，对糖尿病患者进行眼睛检查和糖尿病肾病测试，以及(C)乳癌、结直肠癌和前列腺癌的筛查。我们将研究在监测、流行病学和最终结果(SEER)中确定的老年联邦医疗保险服务费受益人-联邦医疗保险与乳腺癌、子宫癌、结直肠癌、膀胱癌或前列腺癌相关的数据库，这些患者存活5至25年。我们将确定在1998年1月1日至2001年12月31日的四年期间使用适当的临床预防和糖尿病护理服务的情况。具体地说，我们将(1)比较癌症幸存者与居住在SEER地区的5%未患癌症的老年美国人样本中推荐医疗服务的利用率；以及(2)比较多数人口(非西班牙裔白人)与少数群体：非西班牙裔黑人、西班牙裔和亚洲人对服务的使用情况。我们将对被诊断患有局部癌症的人与患有局部或远处疾病的人使用这些服务的情况进行子集分析。所有分析中的重要协变量包括接受初始治疗的类型(S)(手术或放疗)、患者社会人口学变量、合并症以及提供护理的医生的专业。

DESCRIPTION (provided by applicant) The high 5-year relative survival rates for many cancer types mean that cancer survivors should receive the recommended clinical preventive services, as well as quality health care for other co-existing chronic diseases. It is important, as well as consistent with the Healthy People 2010 objectives, that older Americans, including those of each race and ethnic group, receive these services irregardless of whether they have survived cancer, or not. This study will test if recommended clinical preventive services, including cancer screening, as well as diabetes quality of care guidelines, are met as frequently among elderly Americans who have survived breast, uterine, colon and rectal, bladder, or prostate cancer as among elderly persons without cancer. The services we will study are (a) influenza immunization; (b) the American Diabetes Association's recommended diabetes quality of care measures: the determination of serum hemoglobin Alc (HbA1 c) and low-density lipids (LDL-C), eye examination, and testing for diabetic nephropathy in persons who have diabetes, and (c) screening for breast, colorectal and prostate cancer. We will study elderly Medicare fee-for-service beneficiaries identified in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database with incident breast, uterine, colorectal, bladder or prostate cancer who survived 5 to 25 years We will determine the use of appropriate clinical preventive and diabetes care services in the four-year period from January 1, 1998 through December 31, 2001. Specifically, we will (1) compare the rates of utilization of the recommended care in the cancer survivors to the rates in a 5 percent sample of elderly Americans living in SEER areas who have not had cancer; and (2) compare the use of services in the majority population (non-Hispanic whites) with the minority population groups: non-Hispanic blacks, Hispanics and Asians. We will do a sub-set analysis of use of these services among persons who are diagnosed with localized cancer compared with those with regional or distant disease. Important covariates in all analyses include the type(s) of initial treatment received (surgery or radiation), patient sociodemographic variables, comorbidities, and the specialties of the physicians providing care.