Abstract PD12-10: Patient reported outcomes and health care utilization of UPMC breast cancer survivorship clinic patients
Authors: Gade Kristine , Altieri Dunn Stefanie C. , Ormond Ellen , Bilderback Andrew , Brufsky Jill W , Geramita Emily M. , van Londen G J 
Published: February 2021

Abstract
Background. The number and longevity of cancer survivors is growing due to aging of the population, improving cancer treatments, and earlier detection. The Institute of Medicine has recommended creation of guideline-concordant models of cancer survivorship care and clinics for this growing population with unique needs. There is currently little data on how cancer survivors seen at a survivorship clinic fare compared to those seen in routine oncology clinics in terms of quality of life and health care utilization. At the University of Pittsburgh Medical Center (UPMC), we performed a descriptive analysis of healthcare utilization and patient reported outcomes (PROs) of cancer survivors seen at survivorship clinic compared to at oncology clinics.
Methods. The population consisted of breast cancer patients who received care at UPMC survivorship or oncology clinics (control) between January 2012 and December 2018. PROs were collected at each clinic visit and included the SF-12, the Edmonton Symptom Assessment Scale (ESAS), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scales. Cancer diagnoses and staging were obtained from the UPMC Network Cancer Registry. Patient demographics, mortality, ED visits and inpatient stays were extracted from the electronic medical record. ED utilization and inpatient admissions were examined one-year prior to survivorship care compared to 90-days after the start of survivorship care. Categorical and continuous data were examined by Wilcoxon rank sum tests and likelihood-ratio chi-squared tests, respectively. A p-value &lt;0.05 was considered statistically significant.
Results. Data from 680 cancer survivors were included, of which 285 patients received their follow-up care in survivorship clinic and 395 patients received their follow up care in oncology clinics. Baseline demographics were comparable between the two groups, except survivorship clinic patients (SCPs) had higher 1-year mortality (3.5% vs. 0.5%, p=0.003) and cancer stage (62% vs. 48% ≥ stage II, p=0.044). SCPs had significantly more ED visits at baseline and their number of ED visits remained higher than control once enrolled in survivorship clinic, although this trended down after 90 days in survivorship clinic (table 1). Inpatient visits were significantly increased for SCPs as compared to controls at 90 days after enrollment in survivorship clinic (6.4% with ≥ 1 inpatient admission vs. 1.8%, p=0.003). SCPs had consistently worse PROs compared to controls. Prior to enrolling in survivorship clinic, SCPs had higher rates of moderate to severe depression (22.4% with PHQ-9 score of 10-24 vs. 7.8%, p=0.002) and anxiety (20.6% with GAD-7 scores of 10 - 21 vs. 9.2 %, p&lt;0.001) and this remained elevated at all time points compared to controls, although these rates appeared to decrease over time. SCPs also rate their overall health lower than controls on the SF-12 and they have higher symptom severity across most ESAS symptoms.
Conclusions. Cancer survivors who are referred to and receive care in survivorship clinic have poorer quality of life and higher health care utilization at baseline and over time when compared to patients who receive care in oncology clinics. This observation suggests that survivorship clinics may be seeing cancer survivors with higher symptom burden and health care needs. This warrants future efforts to better understand, support, and prevent morbidity of survivorship clinic patients.
Table 1. ED and Hospital Utilization Among Survivorship Clinic Patients and Controls.Pre-Survivorship ClinicAfter Enrollment in Survivorship Clinic1 Year90 Days# ED VisitsControl (%)Survivorship (%)PControl (%)Survivorship (%)P0345 (87.3)199 (69.8)&lt;0.001382 (96.7)250 (87.7)&lt;0.0011+50 (12.7)86 (30.2)13 (3.3)35 (12.3)# Inpatient Admissions0319 (80.8)225 (79.0)0.341388 (98.2)267 (93.7)0.0031+76 (19.3)60 (21.0)7 (1.8)18 (6.4)
Citation Format: Kristine Gade, Stefanie C. Altieri Dunn, Ellen Ormond, Andrew Bilderback, Jill W Brufsky, Emily M. Geramita, G J van Londen. Patient reported outcomes and health care utilization of UPMC breast cancer survivorship clinic patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-10.