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. 2023 Jun 22;23(1):674.
doi: 10.1186/s12913-023-09683-2.

Educational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer - a SEQUEL cohort study

Anne Katrine Graudal Levinsen  1 , Trille Kristina Kjaer  2 , Thomas Maltesen  3 , Erik Jakobsen  4 , Ismail Gögenur  5   6 , Michael Borre  7 , Peer Christiansen  8   9 , Robert Zachariae  8 , Søren Laurberg  10 , Peter Christensen  10 , Niels Kroman  11   12 , Signe Benzon Larsen  2   13 , Thea Helene Degett  2 , Lisbet Rosenkrantz Hölmich  14 , Peter de Nully Brown  15 , Christoffer Johansen  16   17 , Susanne K Kjær  18   19 , Lau Caspar Thygesen  20 , Susanne Oksbjerg Dalton  2   21
Affiliations

Educational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer - a SEQUEL cohort study

Anne Katrine Graudal Levinsen et al. BMC Health Serv Res. .

Abstract

Background: Many cancer survivors experience late effects after cancer. Comorbidity, health literacy, late effects, and help-seeking behavior may affect healthcare use and may differ among socioeconomic groups. We examined healthcare use among cancer survivors, compared with cancer-free individuals, and investigated educational differences in healthcare use among cancer survivors.

Methods: A Danish cohort of 127,472 breast, prostate, lung, and colon cancer survivors from the national cancer databases, and 637,258 age- and sex-matched cancer-free individuals was established. Date of entry was 12 months after diagnosis/index date (for cancer-free individuals). Follow-up ended at death, emigration, new primary cancer, December 31st, 2018, or up to 10 years. Information about education and healthcare use, defined as the number of consultations with general practitioner (GP), private practicing specialists (PPS), hospital, and acute healthcare contacts 1-9 years after diagnosis/index date, was extracted from national registers. We used Poisson regression models to compare healthcare use between cancer survivors and cancer-free individuals, and to investigate the association between education and healthcare use among cancer survivors.

Results: Cancer survivors had more GP, hospital, and acute healthcare contacts than cancer-free individuals, while the use of PPS were alike. One-to-four-year survivors with short compared to long education had more GP consultations (breast, rate ratios (RR) = 1.28, 95% CI = 1.25-1.30; prostate, RR = 1.14, 95% CI = 1.10-1.18; lung, RR = 1.18, 95% CI = 1.13-1.23; and colon cancer, RR = 1.17, 95% CI = 1.13-1.22) and acute contacts (breast, RR = 1.35, 95% CI = 1.26-1.45; prostate, RR = 1.26, 95% CI = 1.15-1.38; lung, RR = 1.24, 95% CI = 1.16-1.33; and colon cancer, RR = 1.35, 95% CI = 1.14-1.60), even after adjusting for comorbidity. One-to-four-year survivors with short compared to long education had less consultations with PPS, while no association was observed for hospital contacts.

Conclusion: Cancer survivors used more healthcare than cancer-free individuals. Cancer survivors with short education had more GP and acute healthcare contacts than survivors with long education. To optimize healthcare use after cancer, we need to better understand survivors' healthcare-seeking behaviors and their specific needs, especially among survivors with short education.

Keywords: Breast cancer; Colon cancer; Healthcare use; Lung cancer; Prostate cancer; Social inequality; Survivorship.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Population flowchart including 1-9-year Danish survivors of breast, prostate, lung, colon cancer, and cancer-free individuals
Fig. 2
Fig. 2
Mean cumulative number of GP consultations and hospital contacts for cancer survivors and cancer-free individuals. Note that x-axis is not the same
Fig. 3
Fig. 3
RRs of GP, hospital, acute, and PPS contacts among 1-4-year-CS with short versus long education. Long education is the reference for all analyses. All analyses are adjusted for age, sex (except prostate and breast cancer survivor populations), time since diagnosis, year of diagnosis, cohabitations status, comorbidity, and stage. RR, rate ratio; GP, general practitioner; PPS, private practicing specialist; CS, cancer survivors; CI, confidence intervals. Note that x-axis is not the same
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