Impact of diffuse large B-cell lymphoma on visits to different provider specialties among elderly Medicare beneficiaries: challenges for care coordination

Abstract

Newly diagnosed diffuse large B-cell lymphoma (DLBCL) can pose significant challenges to care coordination. We utilized a social-ecological model to understand the impact of DLBCL diagnosis on visits to primary care providers (PCPs) and specialists, a key component of care coordination, over a 3-year period of cancer diagnosis and treatment. We used hurdle models and multivariable logistic regression with the Surveillance Epidemiology and End Result-Medicare linked dataset to analyze visits to PCPs and specialists by DLBCL patients (n = 5,455) compared with noncancer patients (n = 14,770). DLBCL patients were more likely to visit PCPs (adjusted odds ratio, AOR [95% confidence interval, CI]: 1.25 [1.18, 1.31]) and had greater number of visits to PCPs (β, SE: 0.384, -0.014) than noncancer patients. Further, DLBCL patients were more likely to have any visit to cardiologists (AOR [95% CI]: 1.40 [1.32, 1.47]), endocrinologists (1.43, [1.21, 1.70]), and pulmonologists (1.51 [1.36, 1.67]) than noncancer patients. Among DLBCL patients, the number of PCP visits markedly increased during the treatment period compared with the baseline period (β, SE: 0.491, -0.028) and then decreased to baseline levels (-0.464, -0.022). Visits to PCPs and specialists were much more frequent for DLBCL patients than noncancer patients, which drastically increased during the DLBCL treatment period for chronic care. More chronic conditions, treatment side effects, and frequent testing may have increased visits to PCPs and specialists. Interventions to improve care coordination may need to target the DLBCL treatment period, when patients are most vulnerable to poor care coordination.

Fig. 1

Flowchart of sample selection for elderly Medicare beneficiaries with diffuse large B-cell lymphoma.

Fig. 2

Flowchart of sample selection for elderly Medicare beneficiaries with no cancer.

Fig. 3

Differences in any visit to primary care physician and other medical specialists between elderly Medicare beneficiaries with DLBCL and no cancer. SEER-Medicare 2003–2011. Based on the differences in percentages of patients with any visit to provider between DLBCL and noncancer patients. T1: baseline; T2: prediagnosis; T3: treatment; T4: posttreatment; T5: short follow-up; T6: long follow-up. DLBCL diffuse large B-cell lymphoma.

Fig. 4

Unadjusted and adjusted differences in average number of visits to primary care physicians between elderly Medicare beneficiaries with diffuse large B-cell lymphoma and no cancer. SEER-Medicare 2003–2011. Calculated among those with at least one primary care physician visit. T1: baseline; T2: prediagnosis; T3: treatment; T4: posttreatment; T5: short follow-up; T6: long follow-up.