Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark.
Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark.
BMC Health Serv Res. 2023 Jun 22;23(1):674. doi: 10.1186/s12913-023-09683-2.
Many cancer survivors experience late effects after cancer. Comorbidity, health literacy, late effects, and help-seeking behavior may affect healthcare use and may differ among socioeconomic groups. We examined healthcare use among cancer survivors, compared with cancer-free individuals, and investigated educational differences in healthcare use among cancer survivors.
A Danish cohort of 127,472 breast, prostate, lung, and colon cancer survivors from the national cancer databases, and 637,258 age- and sex-matched cancer-free individuals was established. Date of entry was 12 months after diagnosis/index date (for cancer-free individuals). Follow-up ended at death, emigration, new primary cancer, December 31st, 2018, or up to 10 years. Information about education and healthcare use, defined as the number of consultations with general practitioner (GP), private practicing specialists (PPS), hospital, and acute healthcare contacts 1-9 years after diagnosis/index date, was extracted from national registers. We used Poisson regression models to compare healthcare use between cancer survivors and cancer-free individuals, and to investigate the association between education and healthcare use among cancer survivors.
Cancer survivors had more GP, hospital, and acute healthcare contacts than cancer-free individuals, while the use of PPS were alike. One-to-four-year survivors with short compared to long education had more GP consultations (breast, rate ratios (RR) = 1.28, 95% CI = 1.25-1.30; prostate, RR = 1.14, 95% CI = 1.10-1.18; lung, RR = 1.18, 95% CI = 1.13-1.23; and colon cancer, RR = 1.17, 95% CI = 1.13-1.22) and acute contacts (breast, RR = 1.35, 95% CI = 1.26-1.45; prostate, RR = 1.26, 95% CI = 1.15-1.38; lung, RR = 1.24, 95% CI = 1.16-1.33; and colon cancer, RR = 1.35, 95% CI = 1.14-1.60), even after adjusting for comorbidity. One-to-four-year survivors with short compared to long education had less consultations with PPS, while no association was observed for hospital contacts.
Cancer survivors used more healthcare than cancer-free individuals. Cancer survivors with short education had more GP and acute healthcare contacts than survivors with long education. To optimize healthcare use after cancer, we need to better understand survivors' healthcare-seeking behaviors and their specific needs, especially among survivors with short education.
许多癌症幸存者在癌症后会出现晚期效应。合并症、健康素养、晚期效应和寻求帮助的行为可能会影响医疗保健的使用，并可能因社会经济群体而异。我们研究了癌症幸存者的医疗保健使用情况，并与无癌症个体进行了比较，并调查了癌症幸存者中教育差异对医疗保健使用的影响。
我们建立了一个来自国家癌症数据库的 127472 名乳腺癌、前列腺癌、肺癌和结肠癌幸存者以及 637258 名年龄和性别匹配的无癌症个体的丹麦队列。入组时间为诊断/索引日期后 12 个月（对于无癌症个体）。随访截止于死亡、移民、新发原发性癌症、2018 年 12 月 31 日或最多 10 年。从国家登记处提取了关于教育和医疗保健使用的信息，定义为诊断/索引日期后 1-9 年内全科医生（GP）、私人执业专家（PPS）、医院和急性保健就诊次数。我们使用泊松回归模型比较癌症幸存者和无癌症个体的医疗保健使用情况，并调查癌症幸存者中教育与医疗保健使用之间的关系。
癌症幸存者比无癌症个体有更多的 GP、医院和急性保健就诊，但 PPS 的使用情况相似。与教育程度较长的幸存者相比，一至四年期幸存者中，接受 GP 咨询的次数更多（乳腺癌，比率比（RR）=1.28，95%置信区间（CI）=1.25-1.30；前列腺癌，RR=1.14，95%CI=1.10-1.18；肺癌，RR=1.18，95%CI=1.13-1.23；结肠癌，RR=1.17，95%CI=1.13-1.22）和急性接触（乳腺癌，RR=1.35，95%CI=1.26-1.45；前列腺癌，RR=1.26，95%CI=1.15-1.38；肺癌，RR=1.24，95%CI=1.16-1.33；结肠癌，RR=1.35，95%CI=1.14-1.60），即使在调整了合并症后也是如此。与教育程度较长的幸存者相比，一至四年期幸存者中，接受 PPS 咨询的次数较少，而与医院就诊次数则没有关联。
癌症幸存者比无癌症个体使用更多的医疗保健。教育程度较短的癌症幸存者比教育程度较长的幸存者接受更多的 GP 和急性保健服务。为了优化癌症后的医疗保健使用，我们需要更好地了解幸存者的医疗保健寻求行为及其特定需求，尤其是在教育程度较低的幸存者中。
