The number of cancer survivors is expected to grow by 25% over the next decade. Among individuals who survive 5+ years from diagnosis, cardiovascular disease (CVD) is the #1 cause of death. Previous work suggests that cancer survivors are less likely to receive non-cancer preventive care (e.g., flu vaccines, cholesterol screening) than patients who have not had cancer. Thus, it is also possible that cancer survivors receive less attention to CVD risk management. Little is known about this important issue outside of cancer registries and clinical trials, which may have limited generalizability to usual care and racial minorities (who are often underrepresented). Reducing CVD events among cancer survivors ?especially racial minorities ?is an emerging national priority. The goal of this proposal is to understand how patterns of healthcare (including fragmentation of care across multiple providers) and provider specialty affect CVD outcomes for cancer survivors.
The specific aims are to determine associations between healthcare fragmentation, provider specialty, CVD risk management, and CVD outcomes among cancer survivors. The proposed project would be a Diversity Supplement to an existing R01 grant from the National Heart, Lung, and Blood Institute (?Healthcare fragmentation and cardiovascular outcomes?). The existing R01 grant currently considers patients broadly and does not focus on the subgroup of patients who are cancer survivors. Both the parent study and the proposed Supplement are ancillary studies to the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, an ongoing, NIH-funded, prospective cohort study that began in 2003. Robust epidemiologic data from REGARDS have been linked to Medicare claims for 9,000+ community-dwelling participants aged 65+ years. Healthcare fragmentation will be measured from existing Medicare claims and from newly collected surveys (collected by the parent study) on self-reported experiences with care coordination and fragmentation. Provider specialty will be determined from existing Medicare claims. If awarded, this Diversity Supplement will generate evidence to inform the design of interventions to decrease healthcare fragmentation and prevent CVD outcomes for cancer survivors and advance a career at the intersection of cancer care and cardiovascular care.

Public Health Relevance

Among individuals who survive a cancer diagnosis by 5+ years, the most common cause of death is cardiovascular disease, rather than recurrent cancer. Cancer survivors see many different providers, and it is possible that management of their cardiovascular risk factors is not prioritized or well-coordinated. The goals of this Diversity Supplement are to determine the relationship between healthcare fragmentation, provider specialty, and cardiovascular outcomes among cancer survivors and, in the process, to advance a career at the intersection of oncology care and cardiovascular care.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Fine, Larry
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Weill Medical College of Cornell University
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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