Review
Long-term survivors of adult cancers and uptake of primary health services: A systematic review

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Abstract

Aim

The aim of this paper is to systematically review the literature on the use of primary and community care services by long-term survivors of adult cancers.

Methods

We conducted a systematic search of eight databases and considered papers looking at primary care aspects of surviving cancer at least 3 years past diagnosis.

Results

Ten eligible papers in four categories: consultation rates in primary care, cancer screening, use of preventative services and chronic disease management. There was no conclusive evidence that cancer survivors have increased rates of consultation in primary care. The studies reported that cancer screening is well managed in survivors. Preventative and chronic care is worse in long-term colorectal cancer survivors compared with long-term breast cancer survivors and controls.

Conclusion

We found little research, especially outside the United States, relating to the care of long-term cancer survivors in primary care. Future work should examine screening for treatment-specific sequelae and the quality of care for co-morbid disease.

Introduction

Due to improvements in the detection and treatment, more people are surviving cancer for many years after diagnosis. Recent statistics indicate that survivors of adult cancer live longer in a cancer-free period; in the UK, 5 and 10 year survival for three of the commonest cancers – breast, colorectal and prostate – has increased steadily since the 1970s.1 Latest estimates indicate that 65% of all people diagnosed with cancer will live for at least 5 years.2 The majority of cancer survivors are over 65 years of age, and if current demographic estimates are correct, by 2050 the number of people aged 65 and over diagnosed with cancer will double.3 The health care needs of this ageing and increasing population are, therefore, becoming increasingly relevant.

Long-term survivors of adult cancer, just like the general population, need to manage their health by participating in preventative care and screening. Cancer survivors, however, have unique health needs as a result of living through cancer and its treatment. The late-effects of radiotherapy and chemotherapy are increasingly well documented, and many survivors face the risk of recurrence and second primary neoplasms.4, 5, 6, 7, 8, 9, 10 The risk of adverse health can potentially be reduced through the uptake of preventative services. Cancer survivors, therefore, have a great need for community-based screening and preventative services to manage late-effects of treatment along with concurrent co-morbidities. Long-term survivors of adult cancer are also likely to access primary care services for care of chronic conditions as well as health promotion and disease prevention services.11

Much of previous research on cancer survivors has concentrated on the survivors of childhood and young adult cancer.12 We have conducted a systematic review of the literature to look at primary care and community based aspects of care for the survivors of cancer diagnosed in adulthood. Specifically, we looked at the uptake of screening, preventative services and the standards of care for cancer-related health needs and co-morbidities. This work aims to provide background data to inform further research in this area with a view of improving the care of long-term survivors of adult cancers.

Section snippets

Literature search

We searched eight electronic databases (MEDLINE, EMBASE, CINAHL, BNI, PsycInfo, HMIC, SSCI and Cochrane databases) from 1990 to February 2007, using search terms relating to survivorship in combination with cancer, family practice, community health care and long-term care (see Appendix A for an example of the Medline search). Two reviewers (NFK and PWR) screened titles and abstracts of all papers in the initial search and excluded citations which did not meet the inclusion criteria.

Results

We identified 1986 papers from the initial database searching, of which we retained 239 potentially relevant papers following abstract review. Of these 239 papers, 229 were excluded as they did not meet the criteria of the review (see Fig. 1). The remainder of the papers (n = 10) were assessed for quality and included in the review. See Table 1 for a summary of study methodology and quality scoring. The results are grouped and presented in four main components: consultation rates in primary care,

Main findings

We have conducted a systematic review that has investigated four aspects of care for survivors of adult cancer managed outside of hospital: consultation rates in primary care, uptake of screening, use of preventative services and chronic disease management. Much of the research comes from the United States from secondary analyses of large datasets.

Only two papers describe consultation rates in primary care in long-term survivors of adult cancer, and the results are inconclusive. However, cancer

Conflict of interest statement

None declared.

Acknowledgement

Funding: Nada Khan’s salary was provided by the Department of Primary Care, University of Oxford and Cancer Research, UK.

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