Background: Many women with breast cancer also cope with other comorbid conditions. They must navigate through a complex and mostly uncoordinated health care system to ensure all their needs are met. The result is that some patients may leave the primary care orbit once breast cancer is diagnosed, disrupting continuity of care for non-cancer conditions. Low income women may be more vulnerable to such disruption. Studies have shown more than one-third to one-half of deaths among breast cancer patients can be attributable to non cancer ? causes. However, to our knowledge, no data have been presented to show the quality of care for comorbid conditions in a primary care setting received by women after breast cancer diagnosis. We propose to examine whether the continuing involvement from a patient's usual primary care providers makes a difference. If patterns of primary care are found to be associated with quality of care for comorbid conditions, future research, interventions, and educational programs can be devised. ? Objectives: Proposed is a 2-year study that will utilize existing datasets originally assembled for a NCI-funded study that focuses on patterns of cancer treatment and survival outcomes for North Carolina Medicaid recipients diagnosed with breast cancer. Our main objectives are (1) to assess the patterns of primary care continuity; and (2) to examine the relationship between the primary care continuity and quality of care for three comorbid conditions (diabetes, hypercholesterolemia, and congestive heart failure).
Specific Aims : We will report the primary care function performed by primary care physicians vs. oncologists across the care continuum: starting with usual patterns of health care established during the 12-month period before cancer diagnosis, during the 12-month period of initial cancer treatment, and the 12-month cancer follow-up period. We will measure the use of recommended preventive services and medication adherence as quality indicators of primary care. We will operationally define continuity and disruption. Three hypotheses will be tested: (1) Patients with comorbid conditions will experience significant disruption in the continuity of seeing their primary care providers after being diagnosed with breast cancer. (2) Such disruption in primary care is associated with sub-optimal management of comorbid conditions. (3) Cancer diagnosis is independently associated with sub-optimal management of a comorbidity, regardless of any patterns in primary care continuity. Study Design: A retrospective cohort of Medicaid-enrolled women will be selected for each comorbid ? condition. The data for each individual will be followed for a minimum of 3 years. For each comorbid disease group, 2 subgroups will be created: 1 with newly diagnosed breast cancer (the study group) and 1 without any cancer diagnosis (the control group). We will utilize a propensity score matching technique to minimize the selection bias between the breast cancer group and the non-cancer group. Logistic regression and survival analysis will be employed for statistical analysis. ? ? ?
