Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.
CMAJ Open. 2021 Apr 1;9(2):E331-E341. doi: 10.9778/cmajo.20200166. Print 2021 Apr-Jun.
Patients with breast cancer visit their primary care physicians (PCPs) more often during chemotherapy than before diagnosis, but the reasons are unclear. We assessed the association between physical comorbidities and mental health history (MHH) and the change in PCP use during adjuvant breast cancer chemotherapy.
We conducted a population-based, retrospective cohort study using data from the Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) project. Participants were women 18 years of age and older, who had received a diagnosis of stage I-III breast cancer in Ontario between 2007 and 2011 and had received surgery and adjuvant chemotherapy. We used difference-in-difference analysis using negative binomial modelling to quantify the differences in the 6-month rate of PCP visits at baseline (the 24-month period between 6 and 30 months before diagnosis) and during treatment (the 6 months from start of chemotherapy) between physical comorbidity and MHH groups.
Among 12 781 participants, the 6-month PCP visit rate increased during chemotherapy (mean 2.3 visits at baseline, 3.4 visits during chemotherapy). Patients with higher physical comorbidity levels or MHH visited their PCPs 4.2 or 1.7 more times, respectively, over 6 months compared to those with low physical comorbidity or no MHH at baseline and 2.5 or 1.1 more times, respectively, over 6 months during treatment. During treatment, the adjusted 6-month rate of PCP visits more than doubled in the group with the fewest physical comorbidities or no MHH compared with baseline (rate ratio 2.52, 95% confidence interval [CI] 2.43-2.61). This increase was lower in those with MHH (rate ratio 1.81, 95% CI 1.68-1.96) and in the highest physical comorbidity group (rate ratio 1.16, 95% CI 1.07-1.28).
Patients with breast cancer who have more physical comorbidities and MHH have a higher frequency of PCP visits during adjuvant chemotherapy but lower absolute and relative increases in visits compared with baseline. Therefore, PCPs can expect to see their patients with fewer physical comorbidities and no MHH more often during chemotherapy. Primary care physicians can plan for their patients with high physical comorbidity levels and MHH to continue having frequent appointments while they undergo chemotherapy, and they can expect their patients with low physical comorbidity levels and no MHH to increase the frequency of their visits during chemotherapy, and should be prepared to provide breast cancer-related care to these patients.
与诊断前相比，接受化疗的乳腺癌患者更频繁地就诊于初级保健医生（PCP），但原因尚不清楚。我们评估了身体合并症和心理健康史（MHH）与辅助乳腺癌化疗期间 PCP 使用变化之间的关联。
我们使用来自加拿大改善社区癌症护理团队（CanIMPACT）项目的数据进行了一项基于人群的回顾性队列研究。参与者为年龄在 18 岁及以上、2007 年至 2011 年间在安大略省被诊断为 I-III 期乳腺癌、并接受了手术和辅助化疗的女性。我们使用负二项式模型进行差异-差异分析，以量化基线（诊断前 6 至 30 个月的 24 个月期间）和治疗期间（化疗开始后 6 个月）身体合并症和 MHH 组 PCP 就诊的 6 个月率差异。
在 12781 名参与者中，化疗期间 PCP 就诊率增加（基线时平均 2.3 次就诊，化疗期间 3.4 次就诊）。与基线时身体合并症低或无 MHH 的患者相比，身体合并症水平较高或有 MHH 的患者在 6 个月内分别多就诊 4.2 次或 1.7 次，而在治疗期间，6 个月内就诊次数分别多 2.5 次或 1.1 次。在身体合并症最少或无 MHH 的患者中，治疗期间 PCP 就诊的调整后 6 个月率比基线时增加了一倍以上（比率为 2.52，95%置信区间[CI]为 2.43-2.61）。MHH 组（比率为 1.81，95%CI 为 1.68-1.96）和身体合并症最高组（比率为 1.16，95%CI 为 1.07-1.28）的增幅较低。
患有乳腺癌且合并症和 MHH 较多的患者在辅助化疗期间 PCP 就诊频率更高，但与基线相比，就诊次数的绝对增加和相对增加均较低。因此，PCP 可以预计他们的患者中身体合并症较少且没有 MHH 的患者在化疗期间会更频繁地就诊。初级保健医生可以计划为身体合并症水平较高且有 MHH 的患者在接受化疗期间继续进行频繁预约，并预计身体合并症水平较低且没有 MHH 的患者在化疗期间增加就诊次数，并应准备为这些患者提供乳腺癌相关护理。
