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Brief ReportBrief Report

Nearly All Cancer Survivors Return to Primary Care

Laura C. Pinheiro, Mangala Rajan, Monika M. Safford, David M. Nanus and Lisa M. Kern
The Journal of the American Board of Family Medicine July 2022, 35 (4) 827-832; DOI: https://doi.org/10.3122/jabfm.2022.04.220007
Laura C. Pinheiro
From Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (LCP, MR, MMS, LMK); Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY (DMN).
PhD, MPH
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Mangala Rajan
From Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (LCP, MR, MMS, LMK); Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY (DMN).
MBA
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Monika M. Safford
From Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (LCP, MR, MMS, LMK); Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY (DMN).
MD
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David M. Nanus
From Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (LCP, MR, MMS, LMK); Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY (DMN).
MD
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Lisa M. Kern
From Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (LCP, MR, MMS, LMK); Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY (DMN).
MD, MPH
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    Figure 1.

    Exclusion cascade for sample derivation.

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    Table 1.

    Cohort Characteristics Between Cancer Survivors With and Without a Primary Care Dominant Provider

    CategoryPrimary Care Dominant (n = 519)Non-Primary Care Dominant (n = 432)P value
    Age at baseline (median [IQR])73 [68 to 78]74 [69 to 78]0.155
    Race0.376
        Black145 (27.9%)132 (30.6%)
        White374 (72.1%)300 (69.4%)
    Gender0.629
        Female219 (42.2%)189 (43.8%)
        Male300 (57.8%)243 (56.2%)
    Annual household income0.213
        less than $20k101 (19.5%)85 (19.7%)
        $20k-$34k140 (27.0%)136 (31.5%)
        $35k-$74k170 (32.8%)114 (26.4%)
        $75k and above45 (8.7%)35 (8.1%)
        Missing63 (12.1%)62 (14.4%)
    Highest level of education0.324
        Less than high school63 (12.1%)68 (15.7%)
        High school graduate124 (23.9%)101 (23.4%)
        Some college143 (27.6%)116 (26.9%)
        College graduate and above188 (36.2%)146 (33.8%)
    Relationship status0.353
        Married318 (61.3%)245 (56.7%)
        Unmarried201 (38.7%)187 (43.3%)
    Geographic region0.569
        Belt162 (31.2%)122 (28.2%)
        Buckle45 (8.7%)42 (9.7%)
        Non-belt312 (60.1%)268 (62.0%)
    Area of residence0.489
        Missing52 (10.0%)35 (8.1%)
        Rural (<=25% Urban)39 (7.5%)25 (5.8%)
        Mixed (25 to 75% Urban)48 (9.2%)39 (9.0%)
        Urban (>=75% Urban)380 (73.2%)333 (77.1%)
    Physical activity0.390
        None197 (38.0%)159 (36.8%)
        1 to 3 times per week176 (33.9%)133 (30.8%)
        4 or more per week134 (25.8%)127 (29.4%)
    Alcohol consumption0.515
        None312 (60.1%)248 (57.4%)
        Moderate170 (32.8%)156 (36.1%)
        Heavy24 (4.6%)17 (3.9%)
    Smoking status0.673
        Never207 (39.9%)160 (37.0%)
        Past268 (51.6%)234 (54.2%)
        Current41 (7.9%)35 (8.1%)
    Body mass index0.511
        Underweight7 (1.3%)6 (1.4%)
        Normal141 (27.2%)99 (22.9%)
        Overweight220 (42.4%)191 (44.2%)
        Obese150 (28.9%)135 (31.2%)
    History of heart disease0.781
        No364 (70.1%)305 (70.6%)
        Yes143 (27.6%)115 (26.6%)
    Diabetes, taking insulin0.186
        No476 (91.7%)381 (88.2%)
        Yes24 (4.6%)28 (6.5%)
    Hypertension, taking medication0.857
        No175 (33.7%)148 (34.3%)
        Yes343 (66.1%)283 (65.5%)
    General health (Short Form-1)0.545
        Poor21 (4.0%)22 (5.1%)
        Fair75 (14.5%)73 (16.9%)
        Good188 (36.2%)153 (35.4%)
        Very good148 (28.5%)125 (28.9%)
        Excellent86 (16.6%)58 (13.4%)
    Physical Component Summary score0.289
        Median [IQR]48.2 [39.1 to 54.1]48.1 [38.9 to 53.5]
        Missing32 (6.2%)23 (5.3%)
    Mental Component Summary score0.841
        Median [IQR]57.3 [53.2 to 59.9]57.3 [52.9 to 59.8]
        Missing32 (6.2%)23 (5.3%)
    • Note: Stroke belt (Alabama, Arkansas, Louisiana, Mississippi, Tennessee, and the noncoastal regions in North Carolina, South Carolina, and Georgia) and the stroke buckle (the coastal regions within North Carolina, South Carolina, and Georgia).

    • Abbreviation: IQR, interquartile ranges.

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    Table 2.

    Specialty Codes of the Dominant Providers

    Provider Specialty CodeDescription of the Provider Specialty CodePercentage of Beneficiaries in the Study with this Dominant Provider
    11Physician/Internal Medicine*35.4
    8Physician/Family Practice*17.9
    18Physician/Ophthalmology7.4
    6Physician/Cardiovascular Disease†6.0
    7Physician/Dermatology4.0
    20Physician/Orthopedic Surgery3.6
    34Physician/Urology3.1
    29Physician/Pulmonary Disease1.7
    39Physician/Nephrology1.6
    4Physician/Otolaryngology1.4
    48Podiatry1.4
    1Physician/General Practice*1.3
    41Optometry1.3
    10Physician/Gastroenterology1.1
    83Physician/Hematology-Oncology‡1.1
    90Physician/Medical Oncology‡0.7
    16Physician/Obstetrics & Gynecology0.6
    38Physician/Geriatric Medicine0.6
    46Physician/Endocrinology0.6
    66Physician/Rheumatology0.6
    • Notes: Provider specialty codes representing ≤0.5% of beneficiaries were suppressed.

    • ↵* Primary care combines ‘1’,‘8’,‘11’. Provider specialty code ‘11’ includes individuals whose primary specialty is internal medicine.

    • ↵† Cardiology combines ‘6’, and ‘78’.

    • ↵‡ Oncology combines ‘83’,‘90’,‘91’,‘92’. Provider specialty code ‘92’ had 0.2%, ‘91’ had 0.1%, and ‘78’ had 0.1% of beneficiaries.

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The Journal of the American Board of Family     Medicine: 35 (4)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 4
July/August 2022
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Nearly All Cancer Survivors Return to Primary Care
Laura C. Pinheiro, Mangala Rajan, Monika M. Safford, David M. Nanus, Lisa M. Kern
The Journal of the American Board of Family Medicine Jul 2022, 35 (4) 827-832; DOI: 10.3122/jabfm.2022.04.220007

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Nearly All Cancer Survivors Return to Primary Care
Laura C. Pinheiro, Mangala Rajan, Monika M. Safford, David M. Nanus, Lisa M. Kern
The Journal of the American Board of Family Medicine Jul 2022, 35 (4) 827-832; DOI: 10.3122/jabfm.2022.04.220007
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