Sussman Jonathan, Cerasuolo Joshua O, Pond Gregory R, Bainbridge Daryl, Seow Hsien
Department of Oncology, McMaster University, Hamilton, ON, Canada.
ICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
JCO Oncol Pract. 2025 Feb;21(2):188-198. doi: 10.1200/OP.23.00813. Epub 2024 Jul 25.
Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned.
We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship.
Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care.
Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.
尽管有证据表明癌症幸存者的后续护理可由初级保健有效管理，且病情好转的幸存者可以缓解癌症护理系统日益增长的压力，但许多癌症幸存者仍在持续接受肿瘤学家的随访。我们分析了来自加拿大安大略省基于人群的行政数据，以研究在癌症幸存者阶段向以初级保健为主导的后续护理过渡的比率，包括与过渡相关的临床和人口统计学预测因素。
我们进行了一项回顾性队列研究，以描述2006年至2016年安大略省所有乳腺癌患者的癌症幸存者后续护理模式。数据来自安大略癌症登记处和其他相关数据集。我们将护理的幸存者阶段定义为初始诊断后2年开始。使用逻辑回归来探索在幸存者阶段后各年中无肿瘤学就诊的潜在预后因素。
我们的幸存者队列由71,719名乳腺癌患者组成，其中42%的患者在诊断后2年被认为已从肿瘤学护理过渡到初级保健。尽管随着时间的推移，接受肿瘤学就诊的患者数量有所减少，但在幸存者阶段的第5年，仍有四分之一的队列继续接受治疗。回归分析发现，年龄较大、癌症早期阶段、居住距离癌症中心较远、未接受放疗或化疗以及健康状况良好与向初级保健过渡相关。
我们的研究结果有助于确定幸存者中的低风险特征，为从肿瘤学护理向初级保健的最佳过渡提供信息。还需要进一步研究，从肿瘤学家、癌症幸存者和初级保健提供者的定性角度进行研究，以阐明在随访期间过渡时应考虑的其他关键因素。
