Findley Patricia A, Sambamoorthi Usha
School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA.
J Cancer Surviv. 2009 Mar;3(1):43-58. doi: 10.1007/s11764-008-0074-x. Epub 2008 Dec 10.
Long term health in cancer survivors require both preventive health services and certain health behavior practices in order to prevent the major chronic diseases that can occur for any adult in the general population. Despite this we currently do not know the pattern of clinical preventive services and health behaviors of cancer survivors in the US population. The present study examines the patterns of preventive health activities in two domains: clinical preventive services and healthy lifestyle practices in a heterogeneous population of cancer survivors.
Longitudinal analyses of Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2000 through 2004 were conducted. Cancer survivors were defined as individuals diagnosed with cancer in the baseline year and alive in the subsequent year. To address both provider based and behavioral health activities, two categories of care were included: clinical preventive services consisting of influenza immunization, routine physical examination, and a dental check up within the last year using the follow-up year data and healthy lifestyle practices including engaging in moderate/vigorous exercise three times per week, maintaining a body mass index (BMI) within normal range, and not currently smoking. Chi-square tests and Poisson regressions were performed to identify factors that were associated with these preventive health activities.
Unadjusted rates of preventive health activities were as follows: 78% had a routine physical check up, 66% visited the dentist at least annually, and 54% received an influenza immunization. Across healthy lifestyle practices, 80% did not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within normal range. Only 31% received all three clinical preventive services and only 16.5% engaged in all three healthy lifestyle practices. Across both domains of preventive health activities, age, marital status, and education were positively associated with the number of services. Presence of diabetes and poorer mental health were associated with greater number of clinical preventive services and lower number of healthy lifestyle practices. Cancer survivors with fair/poor perception of their mental health had lower number of clinical preventive services and those with fair/poor perception of physical health engaged in lower number of healthy lifestyle practices. Demographic and health status factors impacted the two domains differentially.
DISCUSSION/CONCLUSIONS: The rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor's specific total care needs, including all comorbidities. However, it was also found that cancer survivors are less likely to engage in all types of preventive activities; a one-size-fit-all approach is not recommended for preventive health education and planning for this population.
Our study findings suggest the need to address the overall long term healthcare of cancer survivors by prioritizing and developing individualized preventive plans to optimize care that emphasize education, self care perceptions, and incorporate other comorbidities.
癌症幸存者的长期健康需要预防性健康服务和特定的健康行为习惯，以预防普通人群中任何成年人都可能出现的主要慢性疾病。尽管如此，目前我们并不清楚美国人群中癌症幸存者的临床预防服务模式和健康行为。本研究考察了癌症幸存者异质群体在两个领域的预防性健康活动模式：临床预防服务和健康的生活方式习惯。
对2000年至2004年医疗支出面板调查（MEPS）数据进行纵向分析，该调查是一项具有全国代表性的健康调查。癌症幸存者定义为在基准年份被诊断患有癌症且在随后一年仍存活的个体。为了涵盖基于医疗服务提供者的和行为健康活动，纳入了两类护理：临床预防服务，包括流感疫苗接种、常规体检以及使用后续年份数据统计的过去一年的牙科检查；健康的生活方式习惯，包括每周进行三次中等强度/剧烈运动、保持体重指数（BMI）在正常范围内以及目前不吸烟。进行卡方检验和泊松回归以确定与这些预防性健康活动相关的因素。
预防性健康活动的未调整率如下：78%进行了常规体检，66%至少每年看一次牙医，54%接种了流感疫苗。在健康的生活方式习惯方面，80%不吸烟，52%定期锻炼，37%保持BMI在正常范围内。只有31%接受了全部三项临床预防服务，只有16.5%践行了全部三种健康的生活方式习惯。在预防性健康活动的两个领域中，年龄、婚姻状况和教育程度与服务数量呈正相关。患有糖尿病和心理健康状况较差与更多的临床预防服务和较少的健康生活方式习惯相关。对心理健康感知为一般/较差的癌症幸存者接受的临床预防服务较少，而对身体健康感知为一般/较差的幸存者践行的健康生活方式习惯较少。人口统计学和健康状况因素对这两个领域的影响有所不同。
讨论/结论：预防保健的比率和预测因素因服务类型/领域而异，这表明在制定全面的预防服务和生活方式活动计划时需要个性化，该计划应考虑幸存者的具体总体护理需求，包括所有合并症。然而，研究还发现癌症幸存者参与所有类型预防活动的可能性较小；不建议对这一人群采用一刀切的预防健康教育和规划方法。
我们的研究结果表明，需要通过优先制定和制定个性化的预防计划来优化护理，强调教育、自我护理认知并纳入其他合并症，从而解决癌症幸存者的整体长期医疗保健问题。
