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Ashish Rai, Xuesong Han, Zhiyuan Zheng, K. Robin Yabroff and Ahmedin Jemal

Background: Despite the surge of interest in improving provider communication, empirical research is sparse on the determinants and outcomes of cancer survivors' satisfaction with healthcare provider communication. Methods: Longitudinal Medical Expenditure Panel Survey data spanning 2008 through 2014 was used to identify 4,588 respondents who were ever diagnosed with cancer. A composite score was generated by combining 5 measures of satisfaction. We used multivariate logistic regressions and 2-part models to examine the associations between satisfaction ratings and outcomes, including general, mental, and physical health; office visits; and total healthcare, drug, and out-of-pocket expenditures. Results: The study sample comprised 2,257 nonelderly (age 18–64 years) and 2,331 elderly (age ≥65 years) respondents. Among both age groups, higher satisfaction was associated with fewer comorbidities, fewer year 1 office visits, and absence of year 1 emergency department visits. Membership of higher satisfaction tertile in year 1 was associated with better year 2 mental health (tertile 1 [T1]: predictive margin [PM], 27.1%; tertile 2 [T2]: PM, 35.5%; P=.013; tertile 3 [T3]: PM, 37.0%; P=.005) and general health (T1 [ref]: PM, 30.3%; T3: PM, 38.9%; P=.007) among the elderly. Greater satisfaction was associated with fewer year 2 office visits (T1 [ref]: PM, 7.42 visits; T3: PM, 6.26 visits; P=.038) among the nonelderly; and lower year 2 healthcare expenditures (T1 [ref]: PM, $34,071; T3: PM, $26,995; P=.049) among the elderly. Conclusions: We identified potential differences in cancer survivors' needs and expectations of provider communication based on comorbidities and baseline service use. These results emphasize the need for individualized communication strategies for patients with cancer and survivors shaped by their distinct requirements. Our findings of better health, lower service use, and lower expenditures among more satisfied cancer survivors suggest that interventions to improve provider communication could lead to a more efficient use of healthcare resources.

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Kathryn J. Ruddy, Lindsey Sangaralingham, Rachel A. Freedman, Sarah S. Mougalian, Heather Neuman, Caprice Greenberg, Ahmedin Jemal, Narjust Duma, Tufia C. Haddad, Valerie Lemaine, Karthik Ghosh, Tina J. Hieken, Katie Hunt, Celine Vachon, Cary P. Gross and Nilay D. Shah

Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8–4.6) after definitive breast cancer surgery. In year 1, 78% were screened using mammography alone, 1% using MRI alone, and 8% using both tests; 13% did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19%. Older age was associated with an increased likelihood of mammography and a decreased likelihood of MRI during the first and fifth years. Black race, mastectomy, chemotherapy, and no MRI at baseline were all associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.