Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Autor: Pinheiro LC; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA. lcp2003@med.cornell.edu., Reshetnyak E; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA., Safford MM; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA., Nanus D; Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA., Kern LM; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA.
Jazyk: angličtina
Zdroj: Journal of cancer survivorship : research and practice [J Cancer Surviv] 2021 Apr; Vol. 15 (2), pp. 325-332. Date of Electronic Publication: 2020 Sep 08.
DOI: 10.1007/s11764-020-00933-4
Abstrakt: Purpose: Cardiovascular disease (CVD) is the number one cause of death among 5-year cancer survivors. Survivors see many providers and poor coordination may contribute to worse CVD risk factor control. We sought to determine associations between fragmentation and CVD risk factor control among survivors overall and by self-rated health.
Methods: We included REGARDS participants aged 66+ years who (1) had a cancer history; (2) reported diabetes, hypertension, or hyperlipidemia; and (3) had continuous Medicare coverage. Twelve-month ambulatory care fragmentation was calculated using the Bice-Boxerman Index (BBI). We determined associations between fragmentation and CVD risk factors, defining "control" as fasting glucose < 126 mg/dL or non-fasting glucose < 200 mg/dL for diabetes; blood pressure < 140/90 mmHg for hypertension; and total cholesterol <240 mg/dL, low-density lipoprotein cholesterol < 160 mg/dL, or high-density lipoprotein cholesterol >40 mg/dL for hyperlipidemia.
Results: The 1002 cancer survivors (2+ years since cancer treatment) had mean age of 75 years, 39% were women, and 23% were Black. Among individuals with diabetes (N = 225), hypertension (N = 660), and hyperlipidemia (N = 516), separately, approximately 60% had CVD risk factor control. Overall, more fragmented care was not associated with worse control. However, among cancer survivors with excellent, very good, or good health, more fragmentation was associated with a decreased likelihood of diabetes control (OR 0.78, 95% CI 0.61-0.99), adjusting for confounders.
Conclusions: More fragmented care was associated with worse glycemic control among cancer survivors with diabetes who reported excellent, very good, or good health. Associations were not observed for control of hypertension or hyperlipidemia.
Implications for Cancer Survivors: Reducing fragmentation may support glucose control among survivors with diabetes.
Databáze: MEDLINE
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