Follow-up Care of Underserved Breast Cancer Survivors
Follow-up Care of Underserved Breast Cancer Survivors
Overall, 80.8% of the sample had received annual mammography; this is higher than the BC screening rate (72.4%) in the general population. However, screening examination rates for cervical cancer and colorectal cancer in our sample were lower than the rates in the general population (79.3% vs. 83.0% and 49.6% vs. 58.6%, respectively).Table 1 shows the descriptive statistics among the 579 women in the sample. At 36 months after BC diagnosis, most survivors were visiting both a PCP and surgeon/cancer specialist for their medical care (75.8%). About 2 of 10 women had visited only surgeon/cancer specialists (17.3%) in the past 12 months, and 7% of the women visited only a PCP. The sample predominately comprised less-acculturated Latinas (47.5%), with whites accounting for approximately one-third (33.9%). The average age was approximately 51 years, and about 41% had not graduated from high school. Slightly more than half were married or partnered.
With respect to medical characteristics, about one third of the sample had at least one comorbidity, and more than half were diagnosed either with stage II or stage III BC (62%). More than 70% of the participants reported receiving adjuvant hormone therapy.
The majority of the population reported financial hardship (62%), and about 1 in 5 women had not been able to receive needed medical care because of competing life needs. Almost 40% of the participants reported somewhat/very difficult access to medical care.
In unadjusted analyses (Table 2), survivors who visited both a PCP and surgeon/cancer specialist were most likely to receive annual mammography (83%) (P = .015), and survivors who visited only a PCP were most likely to have had a colonoscopy performed (63.3%) (P = .0007). Survivors who visited only a surgeon/cancer specialist for follow-up care were least likely to receive each medical service.
Table 3 presents the results of the multivariate logistic regression models. After adjusting for potential confounders, women with a PCP visit only or both PCP and surgeon/cancer specialists visits in the past 12 months were more likely to have had annual mammography, a Papanicolaou smear in the past 2 years, and colonoscopy than those who visited only surgeon/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds of receiving each clinical care service among the 3 doctor visit groups, even though the difference for annual mammography was not significant.
Receiving adjuvant hormone therapy also was positively associated with annual mammography and having a Papanicolaou smear done in the past 2 years. In addition, both less-acculturated and more-acculturated Latinas were more likely to have had a Papanicolaou smear done in the preceding 2 years compared with their white counterparts. However, older women were less likely to have had a Papanicolaou smear during the past 2 years. Women with greater ease of access to medical care were more likely to receive a colonoscopy.
Results
Descriptive Statistics
Overall, 80.8% of the sample had received annual mammography; this is higher than the BC screening rate (72.4%) in the general population. However, screening examination rates for cervical cancer and colorectal cancer in our sample were lower than the rates in the general population (79.3% vs. 83.0% and 49.6% vs. 58.6%, respectively).Table 1 shows the descriptive statistics among the 579 women in the sample. At 36 months after BC diagnosis, most survivors were visiting both a PCP and surgeon/cancer specialist for their medical care (75.8%). About 2 of 10 women had visited only surgeon/cancer specialists (17.3%) in the past 12 months, and 7% of the women visited only a PCP. The sample predominately comprised less-acculturated Latinas (47.5%), with whites accounting for approximately one-third (33.9%). The average age was approximately 51 years, and about 41% had not graduated from high school. Slightly more than half were married or partnered.
With respect to medical characteristics, about one third of the sample had at least one comorbidity, and more than half were diagnosed either with stage II or stage III BC (62%). More than 70% of the participants reported receiving adjuvant hormone therapy.
The majority of the population reported financial hardship (62%), and about 1 in 5 women had not been able to receive needed medical care because of competing life needs. Almost 40% of the participants reported somewhat/very difficult access to medical care.
Factors Associated With Receipt of Follow-up Care
In unadjusted analyses (Table 2), survivors who visited both a PCP and surgeon/cancer specialist were most likely to receive annual mammography (83%) (P = .015), and survivors who visited only a PCP were most likely to have had a colonoscopy performed (63.3%) (P = .0007). Survivors who visited only a surgeon/cancer specialist for follow-up care were least likely to receive each medical service.
Table 3 presents the results of the multivariate logistic regression models. After adjusting for potential confounders, women with a PCP visit only or both PCP and surgeon/cancer specialists visits in the past 12 months were more likely to have had annual mammography, a Papanicolaou smear in the past 2 years, and colonoscopy than those who visited only surgeon/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds of receiving each clinical care service among the 3 doctor visit groups, even though the difference for annual mammography was not significant.
Receiving adjuvant hormone therapy also was positively associated with annual mammography and having a Papanicolaou smear done in the past 2 years. In addition, both less-acculturated and more-acculturated Latinas were more likely to have had a Papanicolaou smear done in the preceding 2 years compared with their white counterparts. However, older women were less likely to have had a Papanicolaou smear during the past 2 years. Women with greater ease of access to medical care were more likely to receive a colonoscopy.
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