Abstract
Background/Aims Because of advances in early detection and treatment, many colorectal cancer (CRC) survivors now live for decades. Among survivors, the mortality risk from co-morbid conditions—particularly cardiovascular disease—exceeds the risk from cancer, making the receipt of routine preventive health services important in the survivor population. To date, our knowledge of preventive service use among cancer survivors, especially survivors aged <65 years, remains in its infancy. Using a case/control design, we evaluate receipt of preventive health screenings among HMO-insured CRC survivors.
Methods Tumor registry data available within four geographically diverse HMOs were used to identify CRC cases aged ≥50 years diagnosed with non-metastatic disease and treated with curative intent between 1/1/2000 and 12/31/2008. Age and gender distribution-matched controls without a cancer diagnosis were also identified and assigned a pseudo-diagnosis date. HMO administrative and encounter data were used to identify insurance coverage and treatment dates, and socio-demographic and health care use information. Cases and controls, stratified by age (<65 vs. ≥65), were followed annually for up to five years post-treatment. Differences in annual service use between cases and controls were evaluated using chi-square tests.
Results We identified N = 561 cases and N = 5,114 controls aged <65, and N = 1,268 cases and N = 13,720 controls aged ≥65. Forty six percent of both cases and controls aged <65 and 52%/53% of cases/controls aged ≥65 were female. In the first year following treatment, cases aged <65 were significantly (P <0.01) more likely to use colorectal and cervical cancer screening compared to controls (59 vs. 18%, and 87 vs. 76%, respectively), but significantly less likely to undergo cholesterol testing (30 vs. 48%). An identical pattern was observed among cases aged ≥65 (47 vs. 18%, 93 vs. 79%, and 39 vs. 50%, respectively). Regardless of age, no differences were detected in use of mammography or bone densitometry among female cases and controls. These same differences and similarities persisted through the third year of follow up.
Conclusions CRC survivors, regardless of age, receive recommended preventive health screenings, particularly cancer screening, at rates equal to or exceeding non-cancer controls. However, CRC survivors are less likely to receive cholesterol screening, potentially increasing their risk of cardiovascular-related morbidity.
