A group in Ontario, Canada, designed and implemented a model of care for breast cancer survivors to transition from oncology-led care to primary care in a publicly funded healthcare environment. Survivors in the program used fewer health system resources and had lower healthcare costs when compared with women who received usual care, according to research presented by Soo Jin Seung, from Sunnybrook Health Sciences Centre in Toronto, at the ASCO Cancer Survivorship Symposium.
Most breast cancer survivors have regular follow-up visits with their oncologists for several years after cancer treatment is completed. But the growing practice of transitioning follow-up care to primary care providers (PCPs) has been shown to be safe and acceptable to patients. Such a model was implemented by Cancer Care Ontario in Canada over a 3-year period and was known as the Well Follow-Up Care Initiative (WFCI).
“The common thought about these survivorship models is that they will incur higher costs because PCPs might order more tests and want their patients to see more physicians,” she explained. “So our team decided to conduct a study to compare the health system resources and costs used by women in the WFCI cases to non-transitioned women controls.”
A total of 2324 women (cases) participated in the model, and each patient was matched to a control from the Ontario Cancer Registry. Patients were matched based on region and year of cancer diagnosis. The average age was 64 years in both groups, and the highest proportion of breast cancer stage was stage I, at about 36%.
The average number of family physician visits was 7.3 and 7.9 for cases and controls, respectively. “These numbers were not significantly different, and therefore the hypothesis that PCPs might send patients to see more physicians can be rejected,” she said. “In fact, the cases had significantly fewer visits to specialists like surgeons, medical oncologists, and radiation oncologists.”
While the number of bone scans, CTs, and MRIs were significantly lower for cases, the number of mammograms was significantly higher: 0.83 compared with 0.75 for controls.
The difference in survival probability between the cohorts was significant and in favor of the cases, but this can likely be explained by selection bias: the highest functioning breast cancer survivors tended to be enrolled in WFCI, she pointed out.
Notably, the mean annual cost per WFCI patient was $6575, compared with $10,832 per control, resulting in a cost difference of $4257.
In total, the transitioned WFCI cases had fewer hospitalizations, fewer oncology visits, and fewer diagnostic scans, and the same number of PCP visits over an average of 25 months of follow-up. This resulted in lower costs for the case group and could indicate cost savings to the health system, despite a $1.4-million (Canadian) investment for the survivorship model implementation, she said.
The researchers maintain that the findings from this study provide real-world evidence to inform transition policies for cancer survivors.
