Download Khan 2012 - Macmillan Cancer Support

Survivors of Adult Cancer – their use of primary services
and unmet needs
Nada Khan, (formerly University of Oxford), Kings College London
Email: [email protected]
Summary
This study was funded by Macmillan’s Research Fellowship Scheme. The main aim of the
research was to examine the use of primary care services by cancer survivors and to identify
their unmet needs for health care.
Background
The research focused on the survivors of three types of cancer: breast, colorectal and
prostate. The specific aims of the study were:
1. To compare the use and quality of primary care services in a group of long-term
survivors of breast, colorectal and prostate cancer.
2. To compare the risks associated with being a cancer survivor in a group of long-term
survivors of breast, colorectal and prostate cancer.
3. To investigate the views of long-term cancer survivors on their unmet needs and how
these needs might be addressed.
Data was compiled and analysed from the General Practice Research Database (GPRD),
the National Cancer Intelligence Network and the Office for National Statistics. Data from
the Hospital Episodes Statistics (HES) was also used. The data provided information about
diagnosis, prescriptions, referrals and treatment outcomes. Data was analysed for a group
of 145,662 patients – comprising 29,244 cancer survivors and 116,418 controls. In addition
the study had a qualitative component, comprising qualitative interviews with 40 survivors or
breast, colorectal and prostate cancer.
Findings
The study found differences between cancer survivors and the control group in terms of their
use of primary care services. For example, cancer survivors were found to have a higher
rate of primary care consultations compared to controls up to 10 years post-diagnosis and
accessed more anti-depressants and anxiolytics compared to controls. In addition
differences were found in relation to morbidity and mortality. Breast cancer survivors were
found to be at increased risk of developing heart failure, coronary artery disease,
hypothyroidism and lymphoedema. There was evidence for increased risk of dementia and
diabetes amongst colorectal cancer survivors and all three groups of cancer survivors were
at significantly higher risk of developing osteoporosis more than 5 years post-diagnosis. The
qualitative interviews found that some long-term cancer survivors had on-going needs such
as needs for psychological services, access to complementary therapies and information.
The qualitative interview project is being adapted for use on the Health Talk Online website
(www.healthtalkonline.org) and is expected to be launched in April 2013.
Why is this work important?
There are increasing numbers of adult survivors due to better cancer treatments in an
ageing population. Five- and ten-year survival rates have been improving steadily for the
last 30 years. As more people diagnosed with cancer survive for longer, it is increasingly
important to consider the long-term needs of this group. In the UK, most patients are
followed up in secondary care for three to five years and then discharged back to primary
care. Primary care may be well placed to cater for the needs of these patients. However,
patients are currently discharged back to primary care without any special follow-up
arrangements.
Publications related to this research
Khan NF, Mant D, Carpenter L, Forman D, and Rose PW. Long-term health outcomes in a
British cohort of breast, colorectal and prostate cancer survivors: a database study. Br J
Cancer. 2011 November 8; 105(S1): S29–S37.
Khan NF, Evans J and Rose PW. A qualitative study of unmet needs and interactions with
primary care among cancer survivors. Br J Cancer 105: S46-S51; doi:10.1038/bjc.2011.422
Khan NF, Rose PW, Evans J. Defining cancer survivorship: a more transparent approach is
needed. Journal of Cancer Survivorship. 2011. DOI: 10.1007/s11764-011-0194-6.
Khan NF, Harrison S, Rose PW, Ward A, Evans J. Interpretation and acceptance of the term
‘cancer survivor’: a UK based qualitative study. European Journal of Cancer Care. 2011.
DOI: 10.1111/j.1365-2354.2011.01277.x
Khan NF, Mant D, Rose PW. Quality of care for chronic diseases in a British cohort of longterm cancer survivors. Ann Fam Med. 2010. 8(5):418-24.
Khan NF, Ward AM, Watson E, Rose PW. Consulting and prescribing behaviour for anxiety
and depression in long-term survivors of cancer in the UK. Eur J Cancer. 2010. 46(18):333944.
Khan NF, Carpenter L, Watson E, Rose PW. Cancer screening and preventative care
among long-term cancer survivors in the United Kingdom. Br J Cancer. 2010. 102(7):108590.
Khan NF, Ward A, Watson E, Austoker J, Rose PW. Long-term survivors of adult cancers
and uptake of primary health services: a systematic review. Eur J Cancer. 2008. 44(2):195204.