University of Arizona College of Public Health, Tucson, AZ
Michael T. Halpern , Matthew Urato , Erin E. Kent
Background: Cancer survivors may experience unique challenges in receiving needed healthcare services. However, there is little information on individual-level factors influencing the experience of healthcare services among survivors. Methods: This study used healthcare ratings provided by cancer survivors in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Survey linked to data from NCI’s Surveillance, Epidemiology, and End Results (SEER) Program (SEER-CAHPS). CAHPS data on self-reported general and mental health status and five composite measures of experience with healthcare (customer service, doctor communications, getting care quickly, getting needed care, and getting prescription drugs) were linked to patient sociodemographic and cancer characteristics from SEER. Medicare beneficiaries diagnosed with cancer in SEER regions from 1997-2011 who participated in the CAHPS Medicare Survey at least one year after cancer diagnosis were included. The study included only individuals alive at least one year following CAHPS survey completion, at least age 66, and diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer. Results: Among 23,969 cancer survivors with linked SEER-CAHPS data, higher self-rated general health was associated with higher ratings of care for all survivors except those diagnosed with lung cancer, while higher mental health predicted higher ratings among lung and prostate cancer survivors. Asian survivors generally provided lower ratings than did non-Hispanic White survivors. Among breast and prostate cancer survivors, fee-for-services Medicare (vs. Medicare advantage) was associated with lower customer service ratings but higher ratings for getting prescription drugs. Conclusions: Higher self-reported health status was frequently associated with improved experiences of care, but associations between other factors and healthcare rating varied. Interventions to improve general and mental health status of cancer survivors, such as increased access to palliative care services, may also improve their experience of care; however, efforts to enhance care for survivors need to be tailored to individual survivors’ characteristics.
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