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Use of health services among long-term breast cancer survivors in Spain: longitudinal study based on real-world data

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Abstract

Purpose

This study aimed to evaluate health service utilization in Spain among long-term breast cancer survivors and to compare it with that among women with no history of breast cancer.

Methods

Study based on the SURBCAN cohort includes a sample of long-term breast cancer survivors and a sample of women without breast cancer from 5 Spanish regions. Healthcare utilization was assessed through primary care, hospital visits, and tests during the follow-up period (2012 to 2016) by using electronic health records. Annual contact rates to healthcare services were calculated, and crude and multivariate count models were fitted to estimate the adjusted relative risk of healthcare services use.

Results

Data were obtained from 19,328 women, including 6512 long-term breast cancer survivors. Healthcare use was higher among breast cancer survivors (20.9 vs 16.6; p < 0.0001) and decreased from >10 years of survival. Breast cancer survivors who underwent a mastectomy were more likely to have a primary care visit (RR = 3.10 95% CI 3.08–3.11). Five to ten years survivors were more likely to have hospital inpatient visits and imaging test compared to women without breast cancer (RRa = 1.35 95% CI 1.30–1.39 and RRa = 1.27 95% CI 1.25–1.29 respectively).

Conclusion

This study shows higher use of health services in long-term breast cancer survivors than in women without breast cancer regardless of survival time.

Implications for Cancer Survivors

These results help to estimate the health resources needed for the growing group of breast cancer survivors and to identify risk factors that drive higher use of health services.

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Data availability

Further details of the data analyzed in this work are available from the corresponding author on request.

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Acknowledgments

Anna Jansana is a Ph.D. candidate at the Methodology of Biomedical Research and Public Health program, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain (European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain).

The authors acknowledge the dedication and support of the SURBCAN Study Group (alphabetical order): IMIM (Hospital del Mar Medical Research Institute), Barcelona: Mercè Abizanda, Xavier Castells, Mercè Comas, Laia Domingo, Talita Duarte, Anna Jansana, Javier Louro, and María Sala. Hospital Costa del Sol, University of Malaga: María del Carmen Martínez, Cristóbal Molina, María del Carmen Padilla, and Maximino Redondo. Grupo EpiChron de Investigación en Enfermedades Crónicas, del Instituto Aragonés de Ciencias de la Salud, Aragón: Antonio Gimeno, Manuela Lanzuela, Beatriz Poblador, and Alexandra Prados. Primary Care Research Unit. Gerencia de Atención Primaria, Hospital Universitario 12 de Octubre, Madrid: Ángel Alberquilla, Isabel del Cura, Antonio Díaz, Teresa Sanz, Guillermo Pérez, Ana María Muñoz, Francisco Javier Salamanca, and Óscar Toldos. Grupo de investigación en servicios sanitarios y cronicidad de la Fundación Miguel Servet, Navarra: Javier Baquedano, Rossana Burgui, Javier Gorricho, Berta Ibáñez, Conchi Moreno, and Ibai Tamayo.

Funding

This work was supported by Carlos III Health Institute [PI16/00244] and [PI19/00056] and by FEDER (European Regional Development Fund/European Social Fund) and by the Research Network on Health Services in Chronic Diseases [RD16/0001/0013].

Author information

Authors and Affiliations

  1. Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain

    Anna Jansana, Laia Domingo, Mercè Comas, Javier Louro, Xavier Castells & Maria Sala

  2. European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain

    Anna Jansana

  3. Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain

    Anna Jansana, Laia Domingo, Berta Ibañez, Alexandra Prados, Isabel Del Cura, Maria Padilla-Ruiz, Teresa Sanz, Beatriz Poblador, Ibai Tamayo, Antonio Gimeno, Angel Alberquilla, Mercè Comas, Conchi Moreno, Javier Louro, Javier Baquedano, Javier Gorricho, Xavier Castells & Maria Sala

  4. Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain

    Berta Ibañez, Ibai Tamayo & Antonio Gimeno

  5. IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain

    Alexandra Prados & Beatriz Poblador

  6. Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain

    Isabel Del Cura, Teresa Sanz & Angel Alberquilla

  7. Department of Preventive Medicine and Public Health, University Rey Juan Carlos, Avenida de Atenas, 28922, Alcorcón, Madrid, Spain

    Isabel Del Cura

  8. Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain

    Maria Padilla-Ruiz, Cristobal Molina, Maria del Carmen Martinez & Maximino Redondo

  9. Department of Organization and Communication, Parc Sanitari Pere Virgili, Barcelona, Spain

    Mercè Abizanda

  10. Radiotherapy Department, Miguel Servet University Hospital, Saragossa, Spain

    Manuela Lanzuela

  11. Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain

    Rossana Burgui & Conchi Moreno

  12. Madrid Health Service, Technical Direction of Sanitary Information System, Calle San Martín de Porres, 6- 5ª planta, 28035, Madrid, Spain

    Antonio Diaz Holgado

  13. Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain

    Talita Duarte-Salles

  14. Servicio Navarro de Salud-Osasunbidea, Gerencia de Atención Primaria, Pamplona, Spain

    Javier Baquedano

  15. Servicio de Evaluación y Difusión de resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain

    Javier Gorricho

  16. Autonomous University of Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain

    Xavier Castells

Authors
  1. Anna Jansana
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  2. Laia Domingo
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  3. Berta Ibañez
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  26. Maria Sala
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Contributions

MS, AJ, LD, BI, IDC, AP, and MR made substantial contributions to the design and conception of the study. AD, TS, and IDC took responsibility for the data acquisition of the Madrid sub-cohort; BP, AG, and ML for the Aragon sub-cohort; MP, MCM, and CM for the Costa del Sol sub-cohort; JG, JB, CM, and RB for the Navarre sub-cohort; and MS, AJ, JL, TDS, MC, LD, and MA for the Hospital del Mar sub-cohort. AJ took responsibility for data analysis, interpretation, and drafting the article.

MS, LD, MC, XC, BI, AP, MR, IDC provided advice for the study design, critical interpretation of the study, and gave final approval of the version to be published. All of the authors have read and approved the manuscript.

Corresponding author

Correspondence to Maria Sala.

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Ethics approval and consent to participate

This article does not contain any studies with human participants or animals performed by any of the authors. This project was accepted by the Clinical Research Ethics Committee of Parc de Salut Mar (n°2016/6835/I).

Informed consent

For this type of study, formal consent is not required.

Conflict of interest

The authors declare no conflict of interest.

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Jansana, A., Domingo, L., Ibañez, B. et al. Use of health services among long-term breast cancer survivors in Spain: longitudinal study based on real-world data. J Cancer Surviv 16, 132–141 (2022). https://doi.org/10.1007/s11764-021-01011-z

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