Abstract
Introduction
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.
Methods
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.
Results
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.
Implications for cancer survivors
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.
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Notes
Academy of Healthcare Quality and Research, MEPS HC-087 2004 Medical Conditions (2006) http://www.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h87/h87doc.pdf, accessed August 12, 2008.
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The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations. Work for this grant was partially supported by Dr. Findley’s K23 Award under the National Institute of Child Health and Human Development
Appendix
Appendix
Clinical classification code to ICD-9-CM code crosswalk for cancer diagnoses Footnote 1
Cancer of head and neck
1400 1401 1403 1404 1405 1406 1408 1409 1410 1411 1412 1413
1414 1415 1416 1418 1419 1420 1421 1422 1428 1429 1430 1431
1438 1439 1440 1441 1448 1449 1450 1451 1452 1453 1454 1455
1456 1458 1459 1460 1461 1462 1463 1464 1465 1466 1467 1468
1469 1470 1471 1472 1473 1478 1479 1480 1481 1482 1483 1488
1489 1490 1491 1498 1499 1600 1601 1602 1603 1604 1605 1608
1609 1610 1611 1612 1613 1618 1619 1950 2300 2310 V1001 V1002
V1021
Cancer of esophagus
1500 1501 1502 1503 1504 1505 1508 1509 2301 V1003
Cancer of stomach
1510 1511 1512 1513 1514 1515 1516 1518 1519 2302 V1004
Cancer of colon
1530 1531 1532 1533 1534 1535 1536 1537 1538 1539 1590 2303
V1005
Cancer of rectum and anus
1540 1541 1542 1543 1548 2304 2305 2306 V1006
Cancer of liver and intrahepatic bile duct
1550 1551 1552 2308 V1007
Cancer of pancreas
1570 1571 1572 1573 1574 1578 1579
Cancer of other GI organs; peritoneum
1520 1521 1522 1523 1528 1529 1560 1561 1562 1568 1569 1580
1588 1589 1591 1598 1599 2307 2309 V1000 V1009
Cancer of bronchus; lung
1622 1623 1624 1625 1628 1629 2312 V1011
Cancer; other respiratory and intrathoracic
1620 1630 1631 1638 1639 1650 1658 1659 2311 2318 2319 V1012
V1020 V1022
Cancer of bone and connective tissue
1700 1701 1702 1703 1704 1705 1706 1707 1708 1709 1710 1712
1713 1714 1715 1716 1717 1718 1719
Melanomas of skin
1720 1721 1722 1723 1724 1725 1726 1727 1728 1729 V1082
Other non-epithelial cancer of skin
1730 1731 1732 1733 1734 1735 1736 1737 1738 1739 2320 2321
2322 2323 2324 2325 2326 2327 2328 2329 V1083
Cancer of breast
1740 1741 1742 1743 1744 1745 1746 1748 1749 1750 1759 2330
V103
Cancer of uterus
179 1820 1821 1828 2332 V1042
Cancer of cervix
1800 1801 1808 1809 2331 7950 V1041
Cancer of ovary
1830 V1043
Cancer of other female genital organs
181 1832 1833 1834 1835 1838 1839 1840 1841 1842 1843 1844
1848 1849 2333 V1040 V1044
Cancer of prostate
185 2334 V1046
Cancer of testis
1860 1869 V1047
Cancer of other male genital organs
1871 1872 1873 1874 1875 1876 1877 1878 1879 2335 2336 V1045
V1048 V1049
Cancer of bladder
1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 2337 V1051
Cancer of kidney and renal pelvis
1890 1891 V1052
Cancer of other urinary organs
1892 1893 1894 1898 1899 2339 V1050 V1059
Cancer of brain and nervous system
1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921
1922 1923 1928 1929 V1085 V1086
Cancer of thyroid
193 V1087
Hodgkin’s disease
20100 20101 20102 20103 20104 20105 20106 20107 20108 20110 20111 20112
20113 20114 20115 20116 20117 20118 20120 20121 20122 20123 20124 20125
20126 20127 20128 20140 20141 20142 20143 20144 20145 20146 20147 20148
20150 20151 20152 20153 20154 20155 20156 20157 20158 20160 20161 20162
20163 20164 20165 20166 20167 20168 20170 20171 20172 20173 20174 20175
20176 20177 20178 20190 20191 20192 20193 20194 20195 20196 20197 20198
V1072
Non-Hodgkin’s lymphoma
20000 20001 20002 20003 20004 20005 20006 20007 20008 20010 20011 20012
20013 20014 20015 20016 20017 20018 20020 20021 20022 20023 20024 20025
20026 20027 20028 20080 20081 20082 20083 20084 20085 20086 20087 20088
20200 20201 20202 20203 20204 20205 20206 20207 20208 20210 20211 20212
20213 20214 20215 20216 20217 20218 20220 20221 20222 20223 20224 20225
20226 20227 20228 20280 20281 20282 20283 20284 20285 20286 20287 20288
20290 20291 20292 20293 20294 20295 20296 20297 20298 V1071 V1079
Leukemias
20240 20241 20242 20243 20244 20245 20246 20247 20248 2031 20310 20311
2040 20400 20401 2041 20410 20411 2042 20420 20421 2048 20480 20481
2049 20490 20491 2050 20500 20501 2051 20510 20511 2052 20520 20521
2053 20530 20531 2058 20580 20581 2059 20590 20591 2060 20600 20601
2061 20610 20611 2062 20620 20621 2068 20680 20681 2069 20690 20691
2070 20700 20701 2071 20710 20711 2072 20720 20721 2078 20780 20781
2080 20800 20801 2081 20810 20811 2082 20820 20821 2088 20880 20881
2089 20890 20891 V1060 V1061 V1062 V1063 V1069
Multiple myeloma
2030 20300 20301 2038 20380 20381
41 Cancer; other and unspecified primary
1640 1641 1642 1643 1648 1649 1760 1761 1762 1763 1764 1765
1768 1769 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909
1940 1941 1943 1944 1945 1946 1948 1949 1951 1952 1953 1954
1955 1958 20230 20231 20232 20233 20234 20235 20236 20237 20238 20250
20251 20252 20253 20254 20255 20256 20257 20258 20260 20261 20262 20263
20264 20265 20266 20267 20268 2340 2348 2349 7951 V1029 V1081 V1084
V1088 V1089 V109 V711
Secondary malignancies
1960 1961 1962 1963 1965 1966 1968 1969 1970 1971 1972 1973
1974 1975 1976 1977 1978 1980 1981 1982 1983 1984 1985 1986
1987 19881 19882 19889
Malignant neoplasm without specification of site
1990 1991
Neoplasms of unspecified nature or uncertain behavior
2350 2351 2352 2353 2354 2355 2356 2357 2358 2359 2360 2361
2362 2363 2364 2365 2366 2367 23690 23691 23699 2370 2371 2372
2373 2374 2375 2376 2377 23770 23771 23772 2379 2380 2381 2382
2383 2384 2385 2386 2387 2388 2389 2390 2391 2392 2393 2394
2395 2396 2397 2398 2399
Maintenance chemotherapy; radiotherapy
V580 V581 V5811 V5812 V661 V662 V671 V672
Benign neoplasm of uterus
2180 2181 2182 2189 2190 2191 2198 2199
Other and unspecified benign neoplasm
2100 2101 2102 2103 2104 2105 2106 2107 2108 2109 2110 2111
2112 2113 2114 2115 2116 2117 2118 2119 2120 2121 2122 2123
2124 2125 2126 2127 2128 2129 2130 2131 2132 2133 2134 2135
2136 2137 2138 2139 2140 2141 2142 2143 2144 2148 2149 2150
2152 2153 2154 2155 2156 2157 2158 2159 2160 2161 2162 2163
2164 2165 2166 2167 2168 2169 217 220 2210 2211 2212 2218
2219 2220 2221 2222 2223 2224 2228 2229 2230 2231 2232 2233
22381 22389 2239 2240 2241 2242 2243 2244 2245 2246 2247 2248
2249 2250 2251 2252 2253 2254 2258 2259 226 2270 2271 2273
2274 2275 2276 2278 2279 22800 22801 22802 22803 22804 22809 2281
2290 2298 2299 V1272
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Findley, P.A., Sambamoorthi, U. Preventive health services and lifestyle practices in cancer survivors: a population health investigation. J Cancer Surviv 3, 43–58 (2009). https://doi.org/10.1007/s11764-008-0074-x
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DOI: https://doi.org/10.1007/s11764-008-0074-x