The 2005 Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor: Lost in Transition documents the many challenges cancer survivors face in obtaining quality follow-up care (IOM, 2005). In addition to the required surveillance for recurrence, survivors need general primary and preventive care and, for many survivors, care for comorbid conditions. In previous research, we have investigated how being a cancer survivor affects the quality of preventive care received. Cancer survivorship may also have important implications for the quality of care received for comorbid conditions. Earle &Neville (2004) previously evaluated the care for comorbid conditions received by five-year survivors of colorectal cancer who were diagnosed in 1991-1992. This study will update the previous research to survivors diagnosed in 2004 and also expand the patient population to include colorectal, prostate, and breast cancer survivors. These three tumor types account for half of the estimated 11.1 million cancer survivors living in the United States. Our primary analyses will examine each cancer type separately. Doing so will enable us to make useful comparisons across the different cancers and to look for trends in the findings. In addition, because the period immediately following the end of active treatment is a particularly important time of transition, the study will examine care during the first two years of survivorship (defined as days 366 through 1095 from diagnosis). To conduct the study, we will use the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database supplemented with information from the American Medical Association masterfile. This database combines the clinical cancer data available from the SEER program of registries with the health services utilization data available from Medicare administrative claims. We will use the quality indicators for chronic care and avoidable outcomes developed by Asch et al. (2000) and implemented by Earle &Neville (2004) to evaluate the quality of care cancer survivors receive for their comorbid conditions.
Our specific aims are the following: (1) to compare the quality of care for chronic comorbid conditions between survivors of breast, prostate, and colorectal cancer and non-cancer controls, examining each cancer type separately, (2) to compare the rates of avoidable outcomes between survivors of breast, prostate, and colorectal cancer and non-cancer controls, examining each cancer type separately, and (3) to compare the association between quality indicators and costs among survivors of breast, prostate, and colorectal cancer and matched controls, examining each cancer type separately. The results of this study will inform interventions to improve the quality of care for cancer survivors.

Public Health Relevance

This study builds upon and moves beyond previous research examining the quality of care for cancer survivors. It focuses on the relatively understudied area of how having a history of cancer affects the quality of care received for chronic comorbid conditions. Because of the high prevalence of comorbid conditions among cancer survivors, this question is of critical importance.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-G (03))
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Yabroff, Robin
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Pollack, Craig Evan; Frick, Kevin D; Herbert, Robert J et al. (2014) It's who you know: patient-sharing, quality, and costs of cancer survivorship care. J Cancer Surviv 8:156-66
Snyder, Claire F; Frick, Kevin D; Herbert, Robert J et al. (2013) Quality of care for comorbid conditions during the transition to survivorship: differences between cancer survivors and noncancer controls. J Clin Oncol 31:1140-8