Claims-based measures of care coordination and long-term health among older women with endometrial cancer

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Abstract By the year 2030, the number of U.S. women with an endometrial cancer history is expected to exceed 1 million. The care needs of older endometrial survivors include not only regular follow-up visits for detection of cancer recurrence, but also the prevention and management of other non-cancer medical conditions. Cardiovascular disease (CVD) may be of especially critical concern, given the role of obesity as a shared risk factor for both endometrial cancer and CVD. Care for non-cancer conditions, as well as general preventive care and management of side effects of cancer treatment, is likely to require the involvement of primary care physicians or other specialists, in addition to the gynecologists and/or gynecologic oncologists who may perform the recommended follow-up exams for detection of endometrial cancer recurrence, but may not have the expertise to manage other medical conditions. The resulting complexity of healthcare needs for endometrial cancer survivors may lead to fragmentation of care, suboptimal care quality, and, ultimately, poorer health outcomes. Strategies to improve surveillance and management of CVD and other chronic conditions during survivorship, while also ensuring that women receive the recommended follow-up visits specific to their cancer history, are needed to support the complex health needs of endometrial cancer survivors. Care coordination refers to efforts to organize patient care activities between two or more providers involved in the patient’s care to facilitate the appropriate delivery of health care services. Measures of care coordination, which model shared patient networks by connecting physicians with common patients, have been developed using administrative claims data, and have been validated as a means of accurately representing provider communication patterns. We propose to utilize the Surveillance, Epidemiology, and End Results (SEER)- Medicare linked data resource to examine associations between claims-based measures of care coordination and long-term health outcomes after endometrial cancer. Specifically, we will assess whether higher degrees of care coordination during years 1-3 after endometrial cancer diagnosis are predictive of greater adherence to guideline-recommended follow-up for detection of endometrial cancer recurrence, lower risk of CVD diagnoses, lower risk of hospitalizations and emergency department visits, and higher overall survival. This research will inform the development of targeted interventions that seek to enhance the delivery of endometrial cancer survivorship care and improve patient outcomes.