Kaiser Permanente Southern California, Pasadena, CA
Lauren P. Wallner , Jeffrey M Slezak , Ronald K. Loo , Roshan Bastani , Steven J. Jacobsen
Background: Most men diagnosed with prostate cancer will die from other causes, making preventive care for comorbid diseases of aging critical. However, concerns exist that the diagnosis often focuses subsequent care on prostate-related issues rather than overall health. Therefore, we examined the use of preventive services before and after diagnosis among men with prostate cancer and compared it to non-cancer controls. Methods: 15,631 men enrolled in Kaiser Permanente Southern California who were newly diagnosed with prostate cancer from 2002 through 2008 were matched 1:1 to non-cancer controls on age, race and timing of PSA test. They were passively followed through electronic medical records to determine the use of preventive services, including screening for colorectal cancer (CRC) (colonoscopy and/or fecal occult blood tests), tests for diabetes (glucose and hemoglobin A1c (HbA1c)) and heart disease (lipid panel test) and vaccinations (influenza and pneumococcal) in the 5 years before and diagnosis (or index date for controls). Rates of use were calculated for cases and controls separately and compared using Poisson regression. Results: CRC screening rates were 3-fold greater after diagnosis compared to before and were equivalent across group (Relative Rate (RR): 2.97, 95%CI: 2.89-3.05). The rates of lipid testing were similar before and after diagnosis, but increased an additional 10% in cases relative to controls after diagnosis (RR: 1.10, 95%CI: 1.14-1.25). HbA1c rates were lower among cases when compared to controls both before and after diagnosis (RR: 0.73, 95%CI: 0.72-0.74). Rates of glucose testing increased 25% more in the cases after diagnosis relative to the controls (RR: 1.25, 1.23-1.27), with the highest rate in the first 6 months after diagnosis. Influenza vaccination rates increased 24% after diagnosis in both groups (RR: 1.24, 95%CI: 1.22-1.26). Conclusions: Our results suggest that in this system, once diagnosed with prostate cancer, no less attention is paid to general preventive care. The increased use of preventive services may be the result of an integrated care model, further supporting the importance of the provider and system in the delivery of high quality survivorship care.
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